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 an...
...D...
...he presence of a sinus tract that commu...
...sence of purulence surrounding the...
...ce of acute inflammation as defined by the a...
...e intraoperative cultures or a combination o...
...he presence of PJI is possible even if the...
...Preoperative Evalua...
...ect PJI in patients with any of the fo...
...e patient with a possible PJI should inclu...
...ould be obtained in the history include...
A sedimentation rate or C-reactive protein...
...radiograph should be performed in all patient...
...diagnostic arthrocentesis should be perfo...
...throcentesis is also advised in patients...
...sis may not be necessary if in this situation surg...
...analysis should include a total cell count and...
...analysis can also be performed if clin...
...here the patient is medically stabl...
...or aerobic and anaerobic organisms shoul...
...such as bone scans, leukocyte scans, MRI,...
...Intr...
...perative histopathological examination...
...three and optimally five or six periprosthetic...
When possible (see above), withholdi...
...re 1. Preoperative and Intraoperative Diagn...
Treatment
...Treat...
...ecision regarding surgical management...
...der for debridement and retention of prosthe...
...not meet these criteria but for whom...
...Two-stage Excha...
...tage exchange strategy is commonly used in the...
...-revision sedimentation rate and CRP to a...
...selected circumstances more than one two-...
...One...
...ge or direct exchange strategy for...
...Permanent Resection...
...ent resection arthroplasty may be considered:...
...Amputation...
...hould be the last option considered but ma...
...PJI following...
...STAPHYLOCOCCAL...
Treat with 2-6 weeks of a pathogen-speci...
...otal elbow, total shoulder and total ank...
...ral companion drugs for rifampin include...
...loxacin ( A , II )659...
...dary companion drugs to be used if in v...
...ine, doxycyline ( C , III...
...oral first generation cephalosporins such as ce...
...fampin cannot be used due to allergy, toxicity...
...toring of outpatient IV antimicrobial the...
...finite chronic oral antimicrobial suppression wi...
...ampin alone is NOT recommended for chron...
...and laboratory monitoring for efficacy and to...
...offer chronic suppressive therapy must take into a...
...ive therapy is therefore generally reserve...
...PJI DUE...
...reat with 4-6 weeks of pathogen-specific intraven...
...hed guidelines for monitoring outp...
...definite chronic oral antimicrobial suppressio...
...PJI following...
...eks of pathogen-specific intravenous or...
...toring of outpatient IV antimicrobial the...
...PJI following o...
STAPHYLOCO...
...6 weeks of pathogen-specific intrav...
...mmended oral companion drugs for rifampin i...
...vofloxacin. ( A , II )6...
...companion drugs to be used if in vitro suscept...
...e, doxycycline ( B , III )659...
...irst generation cephalosporins such...
...annot be used due to allergy, toxic...
...w published guidelines to monitor outpatient IV a...
...chronic oral antimicrobial suppression with eithe...
...ne is NOT recommended for chronic...
...laboratory monitoring for efficacy and toxicity...
...to offer chronic suppressive therapy...
...PJI DUE TO O...
...reat with 4-6 weeks of pathogen-specific in...
...llow published guidelines for monitorin...
...nic oral antimicrobial suppression sh...
Af...
...n-specific antimicrobial therapy until 24-48 ho...
...ve 4-6 weeks of pathogen-specific intr...
...ollow published guidelines for monitoring outpatie...
...ure 2. Management of PJI-II...
...anagement of PJI-III - Removal of Prosthesis...
...4. Management of PJI-IV...
...Intravenous or Highly Bioavailable...
...Common Antimicrobials Used for Chronic Oral...
...Generic Brand Names...