A patient with a total knee replacement (TKR) presents 3 weeks post-operatively with fever, wound breakdown, erythema, and purulent discharge. The most appropriate management is:

• A Intravenous antibiotics and close observation
• B Immediate one-stage revision TKR
• C Two-stage revision with antibiotic-loaded cement spacer
• D Wound debridement with polyethylene liner exchange (DAIR procedure) ✓

Explanation

Acute periprosthetic joint infection (PJI) presenting within 4 weeks of surgery (or within 3 weeks of symptom onset) with a well-fixed implant and a susceptible organism is best managed with DAIR — Debridement, Antibiotics, Irrigation, and Retention of the fixed components, with polyethylene liner exchange. Success rates are highest when performed early with well-fixed hardware. IV antibiotics alone are insufficient for established PJI. One-stage revision has limited evidence in acute infection. Two-stage revision (explant + spacer + re-implant after infection control) is reserved for chronic PJI, resistant organisms, or cases where DAIR fails.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.