CINCINNATI, OH · FORT THOMAS, KY

(513) 354-3700

ROBERT PETTIT, MD

Restoring Function. Maximizing Performance.

Orthopaedic Sports Medicine · Beacon Orthopaedics & Sports Medicine

Fellowship-Trained · Board Certified (ABOS) · Mako Robotics Certified · Cincinnati Reds Team Physician

Knee · Preparing for Surgery

Preparing for Your Knee I&D with Liner Exchange (DAIR)

Name: Preparing for Your Knee I&D with Liner Exchange (DAIR)
Creator: Robert Pettit, MD

A Guide to Your Surgery

Procedure

Knee surgery

Setting

Typically outpatient — most patients go home the same day

Anesthesia

General or regional — reviewed with anesthesia

Recovery

Personalized week-by-week protocol

Cartilage defect on the femur — surgery stimulates a healing scar-cartilage patch over the damaged area.

01A Message From Dr. Pettit

Thank you for the opportunity to take part in your care. Our number one goal, along with our team at Beacon Orthopaedics and Sports Medicine, is to improve your quality of life through our knowledge, skill, experience, and — most importantly — compassionate care. Knee I&D with Liner Exchange (DAIR) is a highly effective procedure, but we recognize that surgery can be stressful, and we hope to make this process as smooth as possible.

This guide is a resource to help you and your loved ones understand your upcoming surgery, prepare for the day of surgery, and know what to expect during your recovery. Please keep it with you up to your date of surgery and beyond. Our team is always here to answer your questions — please do not hesitate to contact us about anything.

Sincerely,
Robert J. Pettit, MD

02About Your Knee I&D with Liner Exchange (DAIR)

DAIR — debridement, antibiotics, and implant retention — treats an early or acute infection around a knee replacement. The joint is opened and thoroughly washed, all inflamed tissue is removed, the plastic liner is exchanged for a new one, and the well-fixed metal components are retained. Targeted antibiotics then complete the treatment.

03Is This the Right Procedure for You?

DAIR is recommended for acute infections — within weeks of surgery or of sudden onset in a previously well knee — where the implants remain solidly fixed. It preserves your knee replacement; chronic or loose-implant infections require a different, staged approach, which we will have discussed if it applies.

04Risks to Understand

Serious complications are uncommon, and we take specific steps to prevent each of these — but you should know them:

Persistent or recurrent infection requiring further surgery, including staged revision — the most important risk (DAIR succeeds in roughly 60–80% of well-selected acute cases)
Wound-healing problems
Stiffness after the washout — early motion is encouraged
Blood clots — prophylaxis continues, coordinated with the infection team
Antibiotic side effects — monitored by infectious disease with regular labs
Anesthesia risks

05In the Weeks Before Surgery

Complete your pre-operative clearance. Depending on your age and health, you may need lab work, an EKG, or a visit with your primary care doctor or cardiologist. Our surgery scheduler will tell you exactly what is required
Review your medications with us. Blood thinners (such as warfarin, Eliquis, Xarelto, Plavix, or aspirin) and certain supplements may need to be stopped before surgery
but never stop a prescribed medication without instruction from the prescribing doctor
Stop nicotine. Smoking and vaping slow healing. Stopping even a few weeks before surgery improves your recovery
this is especially important for tendon, ligament, cartilage, and bone healing
Arrange a ride and a helper. You cannot drive yourself home after anesthesia. Plan for a responsible adult to drive you and to stay with you the first night
Prepare your home. Set up a comfortable recovery area with everything within reach, clear tripping hazards and loose rugs, and stock easy meals. If you will use crutches, a walker, a sling, or a brace, practice with it ahead of time
Fill prescriptions early. If Dr. Pettit sends pain medication or other prescriptions before surgery, fill them ahead of time so they are ready when you get home.
Stop NSAIDs and blood thinners as directed
Arrange a ride home and help for the first few days
Follow fasting instructions before surgery

06The Day of Surgery

Our surgery scheduler will give you your exact arrival time and location, and will tell you when to stop eating and drinking — generally nothing to eat or drink after midnight the night before, unless you are told otherwise. Take only the medications we tell you to take, with a small sip of water. Leave jewelry and valuables at home, wear loose, comfortable clothing, and bring your photo ID, insurance card, and this guide. Most of our procedures are outpatient, meaning you go home the same day. You will meet the anesthesia team before your procedure to review your anesthesia plan and answer any questions.

07What to Expect After Surgery

Expect a hospital stay of a few days while cultures identify the organism and IV antibiotics begin.

An infectious-disease specialist directs the antibiotic course — commonly ~6 weeks IV, often followed by oral suppression. Completing it exactly as prescribed is as important as the surgery.
Weight-bearing as tolerated with early motion, per your team.
Watch the wound daily and report drainage, spreading redness, or fever immediately.

08Post-Op Quick Reference

Weight-bearing / arm use: Weight-bearing as tolerated with walker/cane support early.
Brace / sling: None typically.
Physical therapy: Early motion and quad work in hospital, then progressive therapy. Protocol: robertpettitmd.com/protocols/i-d-knee.html
Blood-clot prevention: Continues per plan, coordinated with the antibiotic regimen.
Follow-up: Close: wound checks, lab monitoring with infectious disease, and surgeon follow-up at 2 and 6 weeks.

Medication management

You have been given a regional anesthetic block prior to your operation; this will wear off in the evening following your surgery. We recommend taking pain medication once you feel the block wearing off. You may find it beneficial to sleep in a recliner or propped up with pillows in the days following surgery.

Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.

Journavx (Suzetrigine): You have been prescribed Journavx (Suzetrigine) — this is a nonopioid medication to help control your pain. This medication comes from Sycamore Hills Pharmacy in Blue Ash, Ohio, and they will deliver it to your home — it will not be part of your other surgical medication bundle from your regular pharmacy. Please look out for a text from Sycamore. You can take Oxycodone for severe pain as needed every 4-6 hours, in addition to the Journavx and Tylenol/Motrin. If you take hormonal birth control, you will need to use a back-up method while taking Journavx.
DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation. If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
If you have any questions or concerns about narcotic strength medications, please contact us.

Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea

Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Celebrex 200mg twice daily, or Meloxicam 7.5mg twice daily) starting the day of surgery. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed with food to help reduce swelling and pain. Do not take other NSAIDs (Ibuprofen, Advil, Aleve, etc) while taking Celebrex or Meloxicam.

Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms. Take this as needed, it will make you drowsy.

Antibiotic: Your antibiotic regimen after a DAIR is specific to your infection and is listed in your operative note and discharge paperwork. Take it exactly as prescribed and do not stop or change it without talking to Dr. Pettit or the infectious disease team. Do not let the prescription run out before your follow-up visit.

Blood clot prevention (DVT prophylaxis): If you can take Aspirin without any difficulty and are NOT CURRENTLY on any anticoagulation, take Aspirin 81 mg twice daily for 4 weeks, starting the day after your surgery. If you were on 81 mg of Aspirin prior to surgery, please resume this dose after 2 weeks. If you take a prescription blood thinner, restart it only as directed.

Tylenol and Celebrex/Ibuprofen are the foundation for your pain control regimen. Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat — every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain. *You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

09Common Questions

Will I lose my knee replacement?
DAIR exists to save it. When infection is caught early and treated aggressively, the majority of patients keep their original components.

Why is the plastic liner changed?
Bacteria form a biofilm on surfaces — exchanging the removable liner and washing the fixed components removes the most contaminated part and lets us clean behind it.

How will we know it worked?
Steadily settling pain and swelling, normalizing labs (CRP/ESR), and a quiet knee off antibiotics. We follow you closely for a full year.

10Questions & Scheduling

Once you and Dr. Pettit decide on surgery, our surgery scheduler will handle your surgery date, insurance authorization, pre-operative clearances, and exact arrival instructions. Maria Dodd, PA-C helps manage your recovery — medications, imaging, and questions — throughout.

Surgery scheduling & direct office line: (513) 441-5639 · Main office: (513) 354-3700

Scan for the latest version online

robertpettitmd.com/handouts/prepare/dair-poly-exchange.pdf

This guide is for general patient education and does not replace personalized medical advice. Always follow the specific instructions given by Dr. Pettit and your care team.