Morbid Obesity Is a Risk Factor for Infection Recurrence Following Debridement, Antibiotics, and Implant Retention for Periprosthetic Joint Infection

Although morbid obesity is an established risk factor for periprosthetic joint infection following total hip arthroplasty and total knee arthroplasty, little is known regarding the infection control rate of this cohort following debridement, antibiotics, and implant retention (DAIR). The purpose of this study is to investigate the infection control rate following DAIR in a morbidly obese patient cohort compared to a nonobese patient cohort and discern the relationship between time from diagnosis to treatment and risk of DAIR failure.

Results of all DAIR procedures were retrospectively reviewed across 4 institutions. Those with a body mass index of at least 40 kg/m ² were matched 2:1 on the basis of patient age, sex, date of surgery, and presence of staphylococcal species in culture to a cohort of patients with body mass index of <30 kg/m ². Demographic variables were collected for each patient. Kaplan-Meier survivorship curves were constructed and multivariable Cox regression was performed for analysis.

The morbidly obese group experienced a higher treatment failure rate (57.9%) compared to the nonobese group (36.8%; P = .035). Morbid obesity and major depressive disorder/generalized anxiety disorder diagnosis significantly increased the risk of failure, with hazard ratios of 1.82 and 2.09, respectively. Morbidly obese patients who received DAIR within 48 hours of symptom presentation did not face an increased risk of reinfection compared to nonobese patients.

Our findings suggest morbidly obese patients face an increased risk of DAIR failure; however, this risk can be mitigated if DAIR is received within 48 hours of symptom onset.