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
...Definition of...
...f a sinus tract that communicates...
...sence of purulence surrounding the p...
...of acute inflammation as defined by...
Two or more intraoperative cultures or a combina...
...ce of PJI is possible even if the abov...
...Preo...
...ct PJI in patients with any of the following: ( B...
...ation of the patient with a possible PJ...
...d be obtained in the history includ...
...dimentation rate or C-reactive prote...
...graph should be performed in all patients wi...
...hrocentesis should be performed in...
Arthrocentesis is also advised in patients with...
...may not be necessary if in this situation...
...ovial fluid analysis should include a tot...
...crystal analysis can also be performed if...
...PJI where the patient is medically st...
...or aerobic and anaerobic organisms...
...g studies such as bone scans, leukocyte scans...
...histopathological examination of peri-prostheti...
...least three and optimally five or six peripro...
...e (see above), withholding antimic...
...1. Preoperative and Intraoperative...
Treatment
...imate decision regarding surgical management sho...
...r debridement and retention of prosthesi...
...tients who do not meet these criteri...
...Two-st...
...wo-stage exchange strategy is comm...
...pre-revision sedimentation rate and CRP to a...
...d circumstances more than one two-stage exchang...
...One-sta...
...one stage or direct exchange strategy for the...
...Permanent Resection...
Permanent resection arthroplasty may be conside...
...Amputation...
...putation should be the last option considered bu...
...PJI following deb...
...STAPHYLOCOC...
...with 2-6 weeks of a pathogen-specific intraven...
...bow, total shoulder and total ankle infec...
...mended oral companion drugs for rifam...
...floxacin ( A , II )6...
...panion drugs to be used if in vitro sus...
...ne, doxycyline ( C , III...
...first generation cephalosporins such as cep...
...cannot be used due to allergy, tox...
...toring of outpatient IV antimicrobial ther...
...efinite chronic oral antimicrobial su...
...s NOT recommended for chronic suppres...
...cal and laboratory monitoring for e...
...n to offer chronic suppressive therapy mu...
...hronic suppressive therapy is therefore generally...
...PJI DUE TO OTHER...
...t with 4-6 weeks of pathogen-specific intrave...
...w published guidelines for monitor...
...inite chronic oral antimicrobial suppression...
...PJI...
...ks of pathogen-specific intravenous or highly b...
...outpatient IV antimicrobial therapy should...
...PJI followi...
...STAPHYLOCOCCAL PJ...
...with 2-6 weeks of pathogen-specific intra...
...oral companion drugs for rifampin inc...
levofloxacin. ( A , I...
...panion drugs to be used if in vitro sus...
minocycline, doxycycline ( B , III...
...generation cephalosporins such as cephal...
If rifampin cannot be used due to alle...
...low published guidelines to monitor outpatie...
...onic oral antimicrobial suppressio...
...lone is NOT recommended for chronic suppressio...
...boratory monitoring for efficacy and toxicity...
...e decision to offer chronic suppressive...
...PJI DUE TO OTHE...
...4-6 weeks of pathogen-specific intravenou...
...hed guidelines for monitoring outpatient IV antim...
...inite chronic oral antimicrobial suppression...
...After Amputat...
...ive pathogen-specific antimicrobial therapy unt...
...f pathogen-specific intravenous or...
...ished guidelines for monitoring ou...
...gure 2. Management of...
...e 3. Management of PJI-III - Removal of Prost...
Figure 4. Management of PJI...
...ble 1. Intravenous or Highly Bioavaila...
...le 2. Common Antimicrobials Used for Chronic...
...rugsHaving trouble viewing table? Expand...