skip to main content

Failed DAIR — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

HardBone & Joint InfectionFailed DAIRSCE Infectious Diseases

A 62-year-old woman develops a prosthetic joint infection of her right knee, diagnosed 18 months after primary total knee replacement. The pathogen is Staphylococcus aureus (MSSA). Despite a 12-week course of IV Flucloxacillin followed by oral Flucloxacillin plus Rifampicin, the infection recurs 3 months after completing antibiotics. What is the next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Two-stage revision arthroplasty (the first DAIR attempt has failed — repeated DAIR is unlikely to succeed)

Failed DAIR for PJI significantly reduces the likelihood of success with a second DAIR attempt (<30% success with repeat DAIR). The standard approach after failed DAIR is two-stage revision arthroplasty: Stage 1 (implant removal, debridement, antibiotic cement spacer, 6 weeks IV antibiotics), interval period (confirm infection control), Stage 2 (reimplantation). Single-stage revision is an option in selected cases. Lifelong suppressive antibiotics may be considered for patients unfit for further surgery.

Reference: BSAC 2023 – PJI guidelines; NICE NG157 2024 – Joint replacement infections