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

...s and Assessment...

...inition of PJ...

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

...he presence of purulence surrounding the prosth...

...e of acute inflammation as defined by the...

...r more intraoperative cultures or a combin...

...nce of PJI is possible even if the...


...perative Evaluation (Figure 1)...

...spect PJI in patients with any of...

Evaluation of the patient with a possible PJI sho...

...ms that should be obtained in the history include...

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

...aph should be performed in all patients...

...arthrocentesis should be performed in all pa...

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

...hrocentesis may not be necessary i...

...nalysis should include a total cell coun...

...l analysis can also be performed if clini...

...where the patient is medically stable, withho...

...tures for aerobic and anaerobic organisms s...

...studies such as bone scans, leukocy...


...aoperative Diagnosis Of PJI

...ntraoperative histopathological ex...

...east three and optimally five or six perip...

...see above), withholding antimicrobial therapy...

.... Preoperative and Intraoperative Diagnosis of PJ...


Treatment

Treatment

The ultimate decision regarding surgical man...


...r debridement and retention of prosthesis patie...

...ts who do not meet these criteria bu...


...wo-stage Exc...

...stage exchange strategy is commonly us...

...in a pre-revision sedimentation rate and C...

...ted circumstances more than one two-stage...


...-stage Exchang...

...tage or direct exchange strategy for...


...rmanent Resectio...

...resection arthroplasty may be cons...


...utation

Amputation should be the last option considered b...


...lowing debridement and retention of the prosthes...

...YLOCOCCAL PJI

...reat with 2-6 weeks of a pathogen-specific...

...elbow, total shoulder and total ankle inf...

...ecommended oral companion drugs for rif...

...floxacin ( A , II )65...

...panion drugs to be used if in vitro suscept...

...doxycyline ( C , III )659

...irst generation cephalosporins such as cepha...

...pin cannot be used due to allergy, t...

...ring of outpatient IV antimicrobial thera...

...nite chronic oral antimicrobial suppression with...

...one is NOT recommended for chronic...

...inical and laboratory monitoring for ef...

...offer chronic suppressive therapy must take...

...ronic suppressive therapy is therefore generally r...

...TO OTHER ORGANISMS...

...t with 4-6 weeks of pathogen-specific intravenou...

...published guidelines for monitorin...

...e chronic oral antimicrobial suppression sh...

...esection arthroplasty with or without plan...

...pathogen-specific intravenous or hi...

...ring of outpatient IV antimicrobial ther...


...llowing one-stage exchange...

...TAPHYLOCOCCAL P...

...with 2-6 weeks of pathogen-specifi...

...commended oral companion drugs for r...

levofloxacin. ( A ,...

...y companion drugs to be used if in vit...

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

...st generation cephalosporins such as ce...

If rifampin cannot be used due to a...

...blished guidelines to monitor outpati...

...chronic oral antimicrobial suppressi...

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

...linical and laboratory monitoring for efficacy and...

...decision to offer chronic suppressiv...

...I DUE TO OTHER ORGANISMS

...t with 4-6 weeks of pathogen-specif...

...ublished guidelines for monitoring out...

...ronic oral antimicrobial suppression should fol...


...r Amputation...

...en-specific antimicrobial therapy...

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

...lished guidelines for monitoring outpati...


.... Management of PJI-II...


...igure 3. Management of PJI-III - Remo...


...gure 4. Management of PJI-...


...venous or Highly Bioavailable Oral Ant...


...on Antimicrobials Used for Chronic Oral...


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