DVIA technique for acute periprosthetic joint infection: a surgical technique and case series

Abstract

Periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. While debridement, antibiotics, and implant retention (DAIR) are a common treatment for acute PJI, its success rate is variable. Intra-articular antibiotic administration and wound healing techniques may enhance infection control and improve clinical outcomes. This study aimed to describe a modified technique combining DAIR with vacuum sealing drainage (VSD) and intra-articular antibiotic infusion (DVIA) for treating acute PJI, and evaluate its clinical feasibility and preliminary outcomes. This retrospective, single-center case series included 31 patients who underwent DVIA (hip: 19; knee: 12) between September 2019 and December 2023. Following DAIR, a technique integrating vacuum-sealed drainage for wound management with intra-articular antibiotic infusion was applied. Inflammatory markers (CRP, ESR) and intra-articular antibiotic concentrations were monitored at multiple time points. Treatment outcomes, CRP and ESR levels, Knee Society Score (KSS), KSS functional score, Harris Hip Score (HHS), and the 36-item Short-Form (SF-36) physical function scale were evaluated over a 12-month follow-up. Infection control was achieved in 90.32% (28/31) of patients. CRP and ESR levels decreased after treatment. Joint function and patient-reported physical function improved during follow-up. Intra-articular vancomycin concentrations measured in a subset of patients exceeded previously reported minimum biofilm eradication concentration (MBEC) thresholds. No catheter-related complications, retrograde infections, or systemic antibiotic-related adverse events were observed. The DVIA technique appears to be a feasible adjunctive strategy for the management of acute PJI, enabling effective local antibiotic delivery and favorable clinical outcomes. These findings are preliminary and warrant further validation in prospective controlled studies.