DAIR (debridement, antibiotics, and implant retention) is an urgent operation to treat early infection of a hip replacement. The joint is washed out, infected tissue removed, and modular components exchanged — while retaining the well-fixed implant stems.
The hip is reopened through the previous incision. All infected and necrotic tissue is removed (debridement). The joint is thoroughly washed with several litres of saline (irrigation). The modular components (femoral head and polyethylene liner) are exchanged for new ones. The well-fixed stems and shell are retained. Antibiotic-loaded cement may be used. Multiple tissue samples are taken for microbiology. The operation takes one to two hours.
DAIR is appropriate for acute periprosthetic joint infection — either early post-operative (within four to six weeks of the primary surgery) or acute haematogenous (sudden onset infection of a previously well-functioning implant). The implant must be well-fixed to bone. For chronic infections, two-stage revision is usually required instead.
Long-term antibiotic suppression alone (lower success rate). Two-stage revision (implant removal, spacer, then reimplantation). One-stage revision at specialist centres. The choice depends on the timing, organism, and implant fixation.
Urgent procedure — performed as soon as infection is suspected. Blood tests (CRP, ESR, white cell count). Joint aspiration for microbiology before starting antibiotics if possible.
Eradication of infection while retaining the implant. Success rates for DAIR are approximately 50–70% for acute infections, depending on the organism and timing. Staphylococcal infections and delayed presentation reduce success rates.
DAIR fails to eradicate infection in approximately 30–50% of cases, requiring further surgery.
Intravenous antibiotics for two to six weeks followed by oral antibiotics for three to six months.
The risk of dislocation is higher after DAIR due to soft tissue compromise.
Persistent low-grade infection requiring implant removal.
The infection may have loosened the implant despite appearing well-fixed.
Many patients with PJI have significant medical comorbidities.
Prolonged antibiotic courses carry their own risks.
General or spinal anaesthesia.
Hospital stay one to two weeks for intravenous antibiotics. PICC line for outpatient IV antibiotics. Regular blood tests to monitor infection markers. Oral antibiotics for three to six months. Physiotherapy for hip rehabilitation. Return to normal activity once infection is confirmed cleared.
Regular blood tests (CRP, ESR). Clinical review at two weeks, six weeks, three months, six months, and one year. Long-term surveillance for late recurrence.
For acute infections treated promptly with DAIR, approximately 50–70% of patients retain their implant. Success depends on the organism — some bacteria (particularly Staphylococcus aureus) are harder to eradicate.
If the infection is not eradicated, two-stage revision is usually needed — the implant is removed, an antibiotic spacer inserted, and a new implant reimplanted after a period of antibiotics (typically three to six months).