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
...iagnosis and Assessment...
...ition of PJI...
...e of a sinus tract that communicate...
...purulence surrounding the prosthesis...
...nce of acute inflammation as defined by the atten...
...traoperative cultures or a combination of preope...
...he presence of PJI is possible even i...
...perative Evaluation (Figure 1)...
...patients with any of the following: ( B , III...
...tion of the patient with a possible PJI sh...
...ould be obtained in the history include...
...tion rate or C-reactive protein should be perf...
A plain radiograph should be performed...
...c arthrocentesis should be performed in all patie...
...is also advised in patients with a chronic painf...
...s may not be necessary if in this s...
...d analysis should include a total cell count...
...l analysis can also be performed if clini...
...I where the patient is medically stable, w...
...ures for aerobic and anaerobic organ...
...tudies such as bone scans, leukocyte scans, MRI,...
...aoperative Diagnosis O...
...histopathological examination of peri-prosthetic t...
...e and optimally five or six periprostheti...
...(see above), withholding antimicrobial...
...1. Preoperative and Intraoperative Diagnosis of...
Treatment
...eatment...
...te decision regarding surgical management should...
...sider for debridement and retention of prosth...
...do not meet these criteria but for...
...tage Exchange...
...change strategy is commonly used in the...
...evision sedimentation rate and CRP to a...
...cumstances more than one two-stage ex...
...stage Exchange...
...irect exchange strategy for the treatment...
...manent Resecti...
...section arthroplasty may be considered: In non...
...putatio...
...tation should be the last option considered but m...
PJI following debridement and retentio...
STAPHYLOCOCCAL...
...t with 2-6 weeks of a pathogen-specifi...
...nage total elbow, total shoulder and to...
...oral companion drugs for rifampin include ciprofl...
...cin ( A , II )659...
Secondary companion drugs to be used...
...e, doxycyline ( C , III )659...
...oral first generation cephalosporins such as cepha...
If rifampin cannot be used due to all...
...of outpatient IV antimicrobial the...
...finite chronic oral antimicrobial suppression with...
...mpin alone is NOT recommended for chronic suppress...
...d laboratory monitoring for efficacy and toxicity...
The decision to offer chronic suppressive ther...
...nic suppressive therapy is therefore generally re...
...JI DUE TO OTHER ORGANI...
...with 4-6 weeks of pathogen-specific intravenous...
...lished guidelines for monitoring o...
...chronic oral antimicrobial suppression should fo...
...following resection arthroplasty with or w...
...athogen-specific intravenous or highly bioavaila...
...itoring of outpatient IV antimicrobial ther...
...ing one-stage exchange...
...YLOCOCCAL PJI ...
...th 2-6 weeks of pathogen-specific intravenous a...
...ecommended oral companion drugs for ri...
...oxacin. ( A , II )659...
Secondary companion drugs to be used...
...ne, doxycycline ( B , III...
...l first generation cephalosporins such as cepha...
...ot be used due to allergy, toxicity or intolerance...
...ished guidelines to monitor outpatient IV antimic...
...chronic oral antimicrobial suppression w...
Rifampin alone is NOT recommended for ch...
...d laboratory monitoring for efficacy and t...
...ion to offer chronic suppressive th...
...TO OTHER ORGANISMS...
...at with 4-6 weeks of pathogen-specific int...
...shed guidelines for monitoring outpatient IV antim...
...e chronic oral antimicrobial suppression shou...
After Amputation
...thogen-specific antimicrobial therapy until...
...weeks of pathogen-specific intraveno...
...llow published guidelines for monitoring out...
...ure 2. Management of P...
...gement of PJI-III - Removal of Pros...
Figure 4. Management of PJI-...
.... Intravenous or Highly Bioavailable Oral Anti...
Table 2. Common Antimicrobials Used for...
...DrugsHaving trouble viewing table?...