Prosthetic Joint Infection

Last updated April 8, 2022

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

...Diagnosis...

...Def...

...e presence of a sinus tract that communicates...

...e of purulence surrounding the prosthesis witho...

...presence of acute inflammation as defined by...

...intraoperative cultures or a comb...

...presence of PJI is possible even if...


...Preoperative E...

...I in patients with any of the following: ( B , I...

...uation of the patient with a possible PJI...

...at should be obtained in the history in...

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

...ain radiograph should be performed in a...

...arthrocentesis should be performed...

...rocentesis is also advised in patie...

...ay not be necessary if in this situation surgery...

...luid analysis should include a total ce...

...nalysis can also be performed if clinica...

...the patient is medically stable, withholdin...

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

...es such as bone scans, leukocyte scans, MR...


...Intraoperative...

...erative histopathological examinatio...

...hree and optimally five or six periprost...

...ble (see above), withholding antimicrobial ther...

...igure 1. Preoperative and Intraoperativ...


Treatment

...Treatment...

...ecision regarding surgical management shou...


...r for debridement and retention of prosthesi...

...who do not meet these criteria but for whom altern...


...Two-stage...

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

...vision sedimentation rate and CRP to as...

...selected circumstances more than one two-sta...


...One-stage Excha...

...e or direct exchange strategy for the tr...


...Permanent Resection...

...ermanent resection arthroplasty may be c...


...Ampu...

...hould be the last option considered but may be ap...


...PJI follow...

...STAPHYLOCOCCAL PJ...

...eat with 2-6 weeks of a pathogen-spec...

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

...ended oral companion drugs for rifampin include...

...vofloxacin ( A , I...

...mpanion drugs to be used if in vitro susceptibi...

...doxycyline ( C , III )659...

...oral first generation cephalosporins s...

...cannot be used due to allergy, toxicity or in...

...ing of outpatient IV antimicrobial therapy...

...chronic oral antimicrobial suppression with c...

...is NOT recommended for chronic suppressio...

...l and laboratory monitoring for effi...

...to offer chronic suppressive therapy m...

...ressive therapy is therefore generally reserve...

...PJI D...

...reat with 4-6 weeks of pathogen-specific...

...hed guidelines for monitoring outpatient IV ant...

...e chronic oral antimicrobial suppressio...

...PJI following rese...

...6 weeks of pathogen-specific intraven...

...tpatient IV antimicrobial therapy should follow p...


...PJ...

...STAPHY...

...eat with 2-6 weeks of pathogen-specific intraven...

...oral companion drugs for rifampin includ...

levofloxacin. ( A , II )...

...companion drugs to be used if in vitro suscep...

...ne, doxycycline ( B , III )659...

...rst generation cephalosporins such as cephalexin o...

...nnot be used due to allergy, toxicity or intoler...

...ollow published guidelines to monitor...

...ic oral antimicrobial suppression wit...

...is NOT recommended for chronic s...

...aboratory monitoring for efficacy and toxici...

...ion to offer chronic suppressive therapy must take...

...PJI DUE TO OTH...

...h 4-6 weeks of pathogen-specific intrav...

...d guidelines for monitoring outpatient I...

...chronic oral antimicrobial suppression sh...


...ve pathogen-specific antimicrobial therapy un...

...of pathogen-specific intravenous or high...

...d guidelines for monitoring outpatient IV an...


...2. Management of PJI-...


...Management of PJI-III - Removal of Pro...


...ure 4. Management of PJI-IV...


...ntravenous or Highly Bioavailable Oral...


...ommon Antimicrobials Used for Chronic Oral Anti...


...le 3. Drugs Generic...