Success of debridement, antibiotics, and implant retention for acute hematogenous periprosthetic joint infection: a systematic review and meta-analysis

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Background : Acute hematogenous periprosthetic joint infection after hip or knee arthroplasty is difficult to treat. The method of debridement, antibiotics, and implant retention (DAIR) is widely used, but reported success rates vary, and predictors of failure remain unclear. Methods : We searched PubMed, Scopus, Web of Science, and Embase from inception through 26 November 2025 for studies reporting outcomes of DAIR in acute hematogenous periprosthetic joint infection. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute tools. The primary outcome was pooled treatment success. Results : Forty-nine studies were included in the qualitative synthesis. Reported success rates ranged from 20 % to 100 %, with a pooled success rate of 64.5 % (95 % confidence interval, 59.3 %–69.4 %; I 2 =72 %, τ 2 =0.44) in the meta-analysis. This pooled estimate describes an average across heterogeneous cohorts and should not be used as a patient-specific prediction. Success was higher in total hip arthroplasty than in total knee arthroplasty (69.4 % vs. 63.2 %). Outcomes improved over time, from 44.9 % before 2010 to 68.7 % in 2020–2025. Staphylococcus aureus infection and prolonged symptom duration before debridement were the most consistently reported predictors of treatment failure, whereas some included studies reported improved outcomes with modular component exchange. Conclusion : DAIR controls infection in about two-thirds of patients with acute hematogenous periprosthetic joint infection. Failure remains common, especially with S. aureus infection or delayed intervention, supporting early diagnosis, prompt surgery, and careful patient selection.