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 PJI...

The presence of a sinus tract that...

...of purulence surrounding the prosthesis...

...acute inflammation as defined by the attendin...

...e intraoperative cultures or a combination of pre...

...of PJI is possible even if the above criteria ar...


...operative Evaluation (Figure 1...

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

...e patient with a possible PJI should in...

...should be obtained in the history include the ty...

...edimentation rate or C-reactive protein sho...

A plain radiograph should be performed in all...

...arthrocentesis should be performed...

...ocentesis is also advised in patien...

...hrocentesis may not be necessary if in this...

...ovial fluid analysis should include...

...crystal analysis can also be performed if clinic...

...re the patient is medically stable,...

...od cultures for aerobic and anaerobic organism...

...udies such as bone scans, leukocyte scans,...


...tive Diagnosis Of PJI...

...histopathological examination of peri-...

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

...possible (see above), withholding antimicrobial t...

...ure 1. Preoperative and Intraoperative Diagnosi...


Treatment

...reatment...

...ultimate decision regarding surgical m...


...ridement and retention of prosthesis patien...

...atients who do not meet these criteria but...


...age Exchange...

A two-stage exchange strategy is co...

...ision sedimentation rate and CRP to assess...

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


...stage Exchange...

...stage or direct exchange strategy for the trea...


...rmanent Resecti...

...t resection arthroplasty may be considered:...


Amputati...

...ation should be the last option con...


...llowing debridement and retention of the...

...LOCOCCAL PJI...

...h 2-6 weeks of a pathogen-specific i...

...al elbow, total shoulder and total...

...al companion drugs for rifampin include ciprofl...

...loxacin ( A , II )659...

...anion drugs to be used if in vitro susceptibility,...

...nocycline, doxycyline ( C , III...

...ral first generation cephalosporins such...

...ot be used due to allergy, toxicity or intol...

...outpatient IV antimicrobial therapy should...

...te chronic oral antimicrobial supp...

...ampin alone is NOT recommended for chronic suppr...

...cal and laboratory monitoring for efficacy and t...

...cision to offer chronic suppressive therapy mus...

...ressive therapy is therefore generally r...

...TO OTHER ORGANISMS...

Treat with 4-6 weeks of pathogen-specific intrave...

...shed guidelines for monitoring outpatient IV anti...

...definite chronic oral antimicrobial suppressio...

...esection arthroplasty with or without plann...

...pathogen-specific intravenous or highly b...

...of outpatient IV antimicrobial therapy shou...


PJI following one-stage...

...LOCOCCAL PJI 

...t with 2-6 weeks of pathogen-specific intr...

...ded oral companion drugs for rifampin include cip...

...loxacin. ( A , II )659...

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

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

...irst generation cephalosporins such as...

...annot be used due to allergy, toxicity or in...

...ollow published guidelines to monitor outpatient...

...te chronic oral antimicrobial suppression...

...alone is NOT recommended for chronic...

...cal and laboratory monitoring for effic...

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

...TO OTHER ORGANISMS...

...with 4-6 weeks of pathogen-specific intravenous o...

...hed guidelines for monitoring outpatient IV antim...

...definite chronic oral antimicrobial suppres...


...ter Amputati...

Give pathogen-specific antimicrobi...

...ks of pathogen-specific intravenous or highly bio...

...llow published guidelines for monitoring outpat...


...igure 2. Management...


...ure 3. Management of PJI-III - Removal o...


...Management of PJI-IV...


...venous or Highly Bioavailable Oral Antimicro...


...le 2. Common Antimicrobials Used for Chr...


...rugsHaving trouble viewing table? Expand...