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...

Definition of PJ...

...presence of a sinus tract that commun...

...e of purulence surrounding the prosthesis without...

...ence of acute inflammation as defined by the at...

...intraoperative cultures or a combinati...

...e of PJI is possible even if the above...


...erative Evaluation (Figure 1)...

...PJI in patients with any of the follow...

Evaluation of the patient with a possible PJI...

...d be obtained in the history include the type of p...

...mentation rate or C-reactive protein sho...

...ograph should be performed in all patients wit...

...diagnostic arthrocentesis should...

...s is also advised in patients with a chronic...

...rocentesis may not be necessary if...

Synovial fluid analysis should include a total...

...stal analysis can also be performed i...

...he patient is medically stable, wit...

...es for aerobic and anaerobic organisms shou...

...g studies such as bone scans, leukocyte scan...


...aoperative Diagnosis Of PJI...

...perative histopathological examinatio...

...ree and optimally five or six perip...

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

...eoperative and Intraoperative Diagnosis of PJI...


Treatment

...atment...

...he ultimate decision regarding surgica...


...onsider for debridement and retention of...

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


Two-stage Exchan...

...stage exchange strategy is commonly used in...

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

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


...age Exchange...

...or direct exchange strategy for the...


...anent Resection

...rmanent resection arthroplasty may be conside...


...putation

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


...llowing debridement and retention of the prosthe...

...LOCOCCAL PJI...

Treat with 2-6 weeks of a pathogen-specific i...

...age total elbow, total shoulder and total...

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

...vofloxacin ( A , II )659

...anion drugs to be used if in vitro su...

...ocycline, doxycyline ( C ,...

...eneration cephalosporins such as cephale...

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

...outpatient IV antimicrobial therapy should...

...efinite chronic oral antimicrobial suppression w...

...in alone is NOT recommended for chronic...

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

...to offer chronic suppressive thera...

...essive therapy is therefore generally res...

...E TO OTHER ORGANISMS...

...with 4-6 weeks of pathogen-specific intravenous o...

...ublished guidelines for monitoring outp...

...finite chronic oral antimicrobial suppres...

...resection arthroplasty with or without plan...

...ks of pathogen-specific intravenous or h...

...ring of outpatient IV antimicrobial therapy shou...


...wing one-stage exchang...

...TAPHYLOCOCCAL PJ...

...weeks of pathogen-specific intrav...

...ended oral companion drugs for rifa...

...vofloxacin. ( A ,...

...anion drugs to be used if in vitro susceptibil...

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

...oral first generation cephalosporins such as...

...fampin cannot be used due to allergy...

...shed guidelines to monitor outpatient IV...

...definite chronic oral antimicrobial suppressi...

...lone is NOT recommended for chronic sup...

...laboratory monitoring for efficacy and tox...

The decision to offer chronic suppr...

PJI DUE TO OTHER ORGANIS...

...4-6 weeks of pathogen-specific intra...

Follow published guidelines for monitoring o...

...nic oral antimicrobial suppression should follow...


...r Amputation...

...-specific antimicrobial therapy until 24-4...

...ive 4-6 weeks of pathogen-specific intravenous o...

...ow published guidelines for monitoring...


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


.... Management of PJI-III - Removal of Prosthesis...


...e 4. Management of P...


...le 1. Intravenous or Highly Bioava...


...mmon Antimicrobials Used for Chron...


...DrugsHaving trouble viewing table? Ex...