limits of implant retention in prosthetic joint infection

Background: Prosthetic joint infection (PJI) represents a significant complication in lower limb arthroplasty, compromising joint function and patient outcomes. The development of bacterial biofilms on prosthetic surfaces creates a protective environment against host immunity and antimicrobial therapy, typically becoming established within two weeks. Consequently, identifying the specific clinical conditions and temporal windows that permit implant retention is critical to avoid treatment failure and subsequent functional morbidity.

Objective: This article aims to define the indications for implant retention in acute PJI and to describe a standardized surgical protocol, termed SYLAC (Synovectomy, Lavage, and Change of modular components), to optimize clinical outcomes.

Key Points: Successful debridement, antibiotics, and implant retention (DAIR) requires adherence to a strict temporal window: three weeks from symptom onset or four weeks postoperatively. Contraindications include documented bacteremia, extensive soft tissue compromise, and high risk as determined by KLICC (>4) or CRIME-80 (>3) scores. The SYLAC protocol emphasizes radical synovectomy and the mandatory exchange of all modular components. Irrigation involves synergistic use of hydrogen peroxide and povidone-iodine, followed by six liters of pulsatile lavage. Postoperative management includes a three-month antibiotic regimen and structured laboratory monitoring. Failure to adhere to these selection criteria or surgical steps increases the risk of chronic infection and the need for radical explantation.

Conclusion: Utilizing a structured decision-making algorithm and a standardized surgical technique allows for a cure rate of approximately 75% in appropriately selected PJI cases. Rigorous patient selection and meticulous surgical execution are essential to preserve prosthetic function and minimize long-term sequelae.