Prosthetic Joint Infection
Key Points
Key Points
The cumulative incidence of prosthetic joint infection among the approximately 1,000,000 primary total hip (THA) and knee (TKA) arthroplasties performed in the United States of America in 2009 varies between ~1-2% over the lifetime of the prosthetic joint, depending on the type of prosthesis and whether the surgery is a primary or revision procedure.
The management of PJI almost always necessitates the need for surgical intervention and prolonged courses of intravenous or oral antimicrobial therapy.
An essential component of the care of patients with PJI is strong collaboration between all involved medical and surgical specialists (eg, orthopedic surgeons, plastic surgeons, infectious disease specialists, internists, etc.).
Diagnosis and Assessment
Diagnosis and Assess...
Definition o...
...f a sinus tract that communicates w...
...e of purulence surrounding the prosthesis...
...acute inflammation as defined by the attendin...
...o or more intraoperative cultures or a co...
...of PJI is possible even if the abo...
...erative Evaluation (Figure 1)
...in patients with any of the following: ( B , I...
...the patient with a possible PJI s...
...should be obtained in the history include the...
...entation rate or C-reactive protein...
...lain radiograph should be performed in all patient...
...stic arthrocentesis should be performed in a...
...centesis is also advised in patients wi...
...may not be necessary if in this sit...
...uid analysis should include a tota...
...crystal analysis can also be performed if cli...
...ere the patient is medically stable, withhold...
...ures for aerobic and anaerobic organisms should b...
...ng studies such as bone scans, leukocyte scans,...
...rative Diagnosis Of PJ...
...raoperative histopathological examinati...
...east three and optimally five or six peripr...
...possible (see above), withholding antimicrobia...
...1. Preoperative and Intraoperative Diagnosi...
Treatment
...eatment...
...cision regarding surgical managemen...
...r debridement and retention of prost...
...do not meet these criteria but for...
...wo-stage Excha...
...-stage exchange strategy is commonly u...
...tain a pre-revision sedimentation...
...selected circumstances more than one two-s...
...tage Exchange...
...ge or direct exchange strategy for the t...
...ent Resection...
...ermanent resection arthroplasty may be cons...
...mputatio...
...ation should be the last option considered b...
...ing debridement and retention of the pr...
...APHYLOCOCCAL PJI
...6 weeks of a pathogen-specific intravenous anti...
...al elbow, total shoulder and total ankle infecti...
...ed oral companion drugs for rifampin incl...
...loxacin ( A , II )65...
...anion drugs to be used if in vitro...
...ne, doxycyline ( C , III...
...al first generation cephalosporins such as cepha...
...in cannot be used due to allergy, toxic...
...utpatient IV antimicrobial therapy sh...
...te chronic oral antimicrobial suppression with...
...e is NOT recommended for chronic suppression, and...
...ical and laboratory monitoring for effica...
...ecision to offer chronic suppressive...
...c suppressive therapy is therefore generally res...
...I DUE TO OTHER ORGAN...
...h 4-6 weeks of pathogen-specific i...
...lished guidelines for monitoring out...
...te chronic oral antimicrobial suppres...
...ng resection arthroplasty with or without plann...
...-6 weeks of pathogen-specific intravenous...
...outpatient IV antimicrobial thera...
...lowing one-stage exchange...
...TAPHYLOCOCCAL P...
...with 2-6 weeks of pathogen-specific intrav...
...nded oral companion drugs for rifampin includ...
...acin. ( A , II )659...
...ion drugs to be used if in vitro susceptib...
...cline, doxycycline ( B , III...
...rst generation cephalosporins such as ce...
...ifampin cannot be used due to allergy, toxicity o...
Follow published guidelines to monitor outp...
...inite chronic oral antimicrobial suppr...
...ampin alone is NOT recommended for chronic suppre...
...cal and laboratory monitoring for efficacy a...
...to offer chronic suppressive therapy m...
...I DUE TO OTHER ORGANISM...
...th 4-6 weeks of pathogen-specific intraven...
...ollow published guidelines for monitoring out...
...e chronic oral antimicrobial suppression sho...
...fter Amputati...
...pathogen-specific antimicrobial th...
...of pathogen-specific intravenous or highly b...
...published guidelines for monitorin...
...igure 2. Management of PJ...
...3. Management of PJI-III - Removal of...
...Management of PJI-IV...
...1. Intravenous or Highly Bioavailable Oral An...
...mmon Antimicrobials Used for Chronic Oral...
...able 3. DrugsHaving trouble viewing tabl...