DAC®, a Hyaluronan Derivative in the Form of a Gel, Is Effective in Preventing Periprosthetic Joint Infection During Arthroplasty Revision in Patients with Comorbidities: A Retrospective, Observational, 1:1-Matched Case–Control Clinical Investigation

Background/Objectives: Joint arthroplasty revision and comorbidities are considered two increased risk factors for periprosthetic joint infection (PJI), a complication that may lead to prolonged hospital stay, continued antibiotic therapy, and serious consequences, including amputation and, in extreme cases, death of the patient. DAC® is an absorbable barrier in the form of a gel that, when applied as a coating, protects implants from bacterial colonization. The aim of this case–control study was to explore whether the device could decrease the risk of PJI in a cohort of patients who underwent arthroplasty revision and were affected by comorbidities. Methods: We carried out a retrospective 1:1-matched case–control investigation in 96 patients who underwent arthroplasty revision between January 2023 and December 2024; these patients had at least 6 months of follow-up, had comorbidities, and were treated with DAC® gel. The control group consisted of 96 subjects who received standard of care. Demographics, comorbidities, type of arthroplasty, adverse event onset, and incidence of PJI were recorded for all patients. Results: No significant differences in relevant demographics, type of arthroplasty revision, or number or type of comorbidities, except for smoking, were observed between the two groups. At 6-month follow-up, no PJIs were recorded in the DAC® treatment group, whereas five (5.2%) PJIs were observed in the control group (p = 0.0235). No adverse event or impairment of implant osseointegration related to the use of DAC® was observed. Conclusions: The DAC® bioabsorbable hydrogel acts as a physical barrier when applied over an arthroplasty revision implant, protecting it from bacterial adhesion and preventing biofilm formation.