Prosthetic Joint Infection

Publication Date: October 6, 2012

Key Points

Key Points

Prosthetic joint infection (PJI) remains one of the most serious complications of prosthetic joint implantation.

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

...nosis and Assessment...

...efinition of PJI

...f a sinus tract that communicates with the prosth...

...e presence of purulence surrounding the pr...

...acute inflammation as defined by the attending...

...re intraoperative cultures or a combination...

...esence of PJI is possible even if the ab...


Preoperative Evaluation (...

...t PJI in patients with any of the following: ( B...

...luation of the patient with a possi...

Items that should be obtained in the...

...sedimentation rate or C-reactive protein...

...plain radiograph should be performed...

...throcentesis should be performed in all patients...

...rthrocentesis is also advised in patients with a c...

...throcentesis may not be necessary if in this situa...

...luid analysis should include a total...

A crystal analysis can also be performed if clini...

...the patient is medically stable, withholding...

...tures for aerobic and anaerobic orga...

...studies such as bone scans, leukocyte scans, M...


...erative Diagnosis Of PJI...

...rative histopathological examination...

...t least three and optimally five or six perip...

...e (see above), withholding antimicrobial th...

...perative and Intraoperative Diagnosis of PJI...


Treatment

...atment

...timate decision regarding surgical managem...


...ider for debridement and retention of prosth...

...who do not meet these criteria but...


...age Exchange...

...change strategy is commonly used in the US a...

...-revision sedimentation rate and CRP to assess...

...selected circumstances more than one two-stag...


...tage Exchange...

...tage or direct exchange strategy for the tr...


...ent Resection...

...tion arthroplasty may be considered: In...


Amputatio...

...ion should be the last option considered but...


...lowing debridement and retention of the prosthesis...

...LOCOCCAL PJI...

...6 weeks of a pathogen-specific intra...

...anage total elbow, total shoulder...

...mended oral companion drugs for rifampin...

...loxacin ( A , II )659...

...companion drugs to be used if in vitro susce...

...ne, doxycyline ( C , III )659...

...generation cephalosporins such as cep...

...cannot be used due to allergy, toxicity or...

...f outpatient IV antimicrobial therapy sho...

...ronic oral antimicrobial suppression with...

...lone is NOT recommended for chronic suppression,...

...inical and laboratory monitoring for efficacy...

...offer chronic suppressive therapy mu...

...ive therapy is therefore generally reserved fo...

...E TO OTHER ORGANISMS...

...reat with 4-6 weeks of pathogen-specific...

...w published guidelines for monitoring out...

...te chronic oral antimicrobial suppression sho...

...JI following resection arthroplasty wit...

...hogen-specific intravenous or highly bioavai...

...tpatient IV antimicrobial therapy should follow...


...I following one-stage e...

...PHYLOCOCCAL PJIÂ...

...at with 2-6 weeks of pathogen-specific...

...ed oral companion drugs for rifampin in...

...loxacin. ( A , II )...

...ompanion drugs to be used if in vitro susceptib...

...line, doxycycline ( B , III )659...

...first generation cephalosporins such as cephal...

If rifampin cannot be used due to allergy, toxici...

...ed guidelines to monitor outpatient IV antimicrob...

...definite chronic oral antimicrobial suppression wi...

Rifampin alone is NOT recommended for chronic supp...

...l and laboratory monitoring for effic...

...ecision to offer chronic suppressive...

...TO OTHER ORGANISMS...

...4-6 weeks of pathogen-specific intravenous or...

...ow published guidelines for monitoring outpatient...

...nic oral antimicrobial suppression...


...r Amputatio...

...pecific antimicrobial therapy until 24-...

...of pathogen-specific intravenous...

...llow published guidelines for monitoring outpatie...


...re 2. Management of PJI-...


...gure 3. Management of PJI-III - Re...


...4. Management of PJI-IV...


Table 1. Intravenous or Highly Bioavailable Oral...


...Antimicrobials Used for Chronic O...


...ving trouble viewing table? Expand...