A 72-year-old man undergoes cemented total hip replacement. Six weeks postoperatively he has acute right groin pain and fever. X-ray shows no implant loosening. CRP 120 mg/L, ESR 90. Hip aspiration grows Staphylococcus aureus. Which of the following is the MOST appropriate treatment based on timing and classification?
- A Debridement, antibiotics, and implant retention (DAIR) with head-liner exchange ✓
- B Prolonged oral antibiotic suppression without surgical intervention
- C One-stage revision arthroplasty with antibiotic-impregnated cement
- D Two-stage revision with spacer insertion followed by reimplantation at 6 weeks
Explanation
This is an acute early periprosthetic joint infection (PJI) — occurring <90 days from surgery (Tsukayama/MSIS classification Type I/early acute). DAIR (debridement, antibiotics, and implant retention) with modular component exchange (head and liner) is the recommended treatment for acute early PJI (<90 days), provided: the implant is stable (not loose), symptoms are <3–4 weeks, the organism is of low virulence or susceptible, and biofilm formation is limited. Two-stage revision is the gold standard for chronic/late PJI or when implants are loose. One-stage revision is debated and used selectively. Antibiotics alone without debridement are inadequate for Staph. aureus PJI.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.