A 68-year-old man presents 3 weeks after cemented THR with acute severe hip pain, fever (38.9°C), raised CRP (210 mg/L), and ESR (95 mm/h). Hip aspiration yields turbid fluid with 48,000 WBC/mm³ (90% PMNs). Culture grows methicillin-sensitive Staphylococcus aureus. The MOST appropriate management is:

• A Prolonged intravenous antibiotics alone for 6 weeks
• B One-stage revision with antibiotic-loaded cement
• C Two-stage revision with spacer placement
• D Debridement, antibiotics and implant retention (DAIR) ✓

Explanation

Within the first 4 weeks (acute postoperative periprosthetic joint infection) with a well-fixed implant and MSSA organism, DAIR (debridement, antibiotics and implant retention) is the preferred strategy provided the implant is still stable and the biofilm has not matured. Appropriate indications for DAIR include: duration <4 weeks from surgery or symptom onset, no sinus tract, well-fixed components, and a sensitive organism. Two-stage revision is reserved for chronic or antibiotic-resistant PJI with established biofilm.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.