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 Asses...
...nition of PJI...
...a sinus tract that communicates with the prost...
...nce of purulence surrounding the prosthesi...
...presence of acute inflammation as defin...
Two or more intraoperative cultures or a...
...ce of PJI is possible even if the above criteria a...
...erative Evaluation (Figure 1)...
...n patients with any of the following: ( B , III )...
...ation of the patient with a possible PJI should in...
...ld be obtained in the history include the t...
...ation rate or C-reactive protein should be...
...plain radiograph should be performed in all pat...
...ic arthrocentesis should be performed i...
...entesis is also advised in patient...
...centesis may not be necessary if in...
...nalysis should include a total cell coun...
...tal analysis can also be performed if...
...he patient is medically stable, withhold...
...cultures for aerobic and anaerobic organisms...
Imaging studies such as bone scans, leukocy...
...erative Diagnosis Of PJI...
...ntraoperative histopathological ex...
At least three and optimally five or s...
...ible (see above), withholding antimicrobial t...
...eoperative and Intraoperative Diagnosis o...
Treatment
...atment...
The ultimate decision regarding su...
...debridement and retention of prosthesis patien...
...ts who do not meet these criteria but for...
...stage Exchange...
...-stage exchange strategy is commonly...
...tain a pre-revision sedimentation rate and CR...
In selected circumstances more than one two-st...
...stage Exchan...
...irect exchange strategy for the treatment of...
Permanent Res...
...resection arthroplasty may be cons...
...mputati...
Amputation should be the last option conside...
...owing debridement and retention of...
...PHYLOCOCCAL PJI...
...2-6 weeks of a pathogen-specific intrav...
...tal elbow, total shoulder and total ankle infecti...
Recommended oral companion drugs for rifampi...
...acin ( A , II )659...
...anion drugs to be used if in vitro susceptibility...
...ine, doxycyline ( C , III )659...
...eneration cephalosporins such as cephalexin o...
...ifampin cannot be used due to allergy, toxici...
...ing of outpatient IV antimicrobial therapy...
...inite chronic oral antimicrobial suppression with...
...pin alone is NOT recommended for chronic suppress...
...nical and laboratory monitoring for effic...
...ecision to offer chronic suppressive...
...pressive therapy is therefore generally res...
...TO OTHER ORGANISMS...
...6 weeks of pathogen-specific intravenous or hi...
...blished guidelines for monitoring out...
...ndefinite chronic oral antimicrobial suppres...
...wing resection arthroplasty with or witho...
...6 weeks of pathogen-specific intravenous...
Monitoring of outpatient IV antimicrobial the...
...lowing one-stage exchange...
STAPHYLOCOCCAL P...
...with 2-6 weeks of pathogen-specific intrave...
Recommended oral companion drugs fo...
...acin. ( A , II )659...
...ondary companion drugs to be used if...
...ne, doxycycline ( B , III )659...
...irst generation cephalosporins suc...
...in cannot be used due to allergy, toxic...
...d guidelines to monitor outpatient IV antimicrobi...
...nite chronic oral antimicrobial suppre...
...alone is NOT recommended for chronic s...
Clinical and laboratory monitoring for efficacy...
...decision to offer chronic suppressi...
...UE TO OTHER ORGANISMS...
...eeks of pathogen-specific intravenous...
...ed guidelines for monitoring outpatient...
...definite chronic oral antimicrobia...
...fter Amputatio...
...ve pathogen-specific antimicrobial therapy u...
...of pathogen-specific intravenous or highly b...
...ished guidelines for monitoring outpatie...
.... Management of PJI-II...
...3. Management of PJI-III - Removal of...
...Management of PJI-IV...
Table 1. Intravenous or Highly Bioavailable Oral...
...ble 2. Common Antimicrobials Used for Chroni...
...3. DrugsHaving trouble viewing table? Exp...