Does a Second DAIR Procedure Identify a More Complex Patient Cohort Prior to Staged Exchange Arthroplasty for Periprosthetic Hip Infection?

<title>Abstract</title> <p>Introduction: To determine whether patients requiring a second debridement, antibiotics, and implant retention (DAIR) represent a more complex cohort with worse outcomes after subsequent staged exchange arthroplasty (EA) for hip periprosthetic joint infection (PJI). Materials and Methods We retrospectively reviewed patients treated with staged EA for hip PJI after one or two prior DAIR procedures between 1994 and 2010, with minimum 10-year follow-up. Patients were stratified into staged EA after one DAIR (n = 96) and after two DAIRs (n = 37). The primary endpoint was reoperation for any reason. Results Reoperation was higher in the second DAIR group (21.6% vs. 11.5%, p = 0.02). Multivariate analysis identified pre-DAIR CRP &gt; 100 mg/L (HR = 2.24), persistent infection (HR = 2.44), and subsequent PJI within three months (HR = 3.46) as independent predictors. A 0–3 risk score stratified ten-year reoperation-free survival from 95.3% to 33.3% (p &lt; 0.001). Conclusions A second DAIR appears to identify patients with more complex infection biology. A three-factor risk score may support selection between repeat DAIR and direct staged EA.</p>