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

Definition of PJI

...esence of a sinus tract that communicat...

...of purulence surrounding the prost...

...ce of acute inflammation as defined by the...

...o or more intraoperative cultures or a combinati...

...resence of PJI is possible even if the above...


...operative Evaluation (Figure 1)

...in patients with any of the following: (...

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

Items that should be obtained in the hist...

...mentation rate or C-reactive protein s...

...ograph should be performed in all patients wit...

...agnostic arthrocentesis should be perform...

...centesis is also advised in patients with a chroni...

...is may not be necessary if in this situa...

...id analysis should include a total cell coun...

...analysis can also be performed if clin...

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

...or aerobic and anaerobic organisms should b...

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


...tive Diagnosis Of PJI...

...histopathological examination of pe...

...e and optimally five or six peripro...

...ssible (see above), withholding antimicrobial...

...e 1. Preoperative and Intraoperative Diagn...


Treatment

Treatm...

...ultimate decision regarding surgical mana...


...bridement and retention of prosthesis pat...

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


...-stage Excha...

...tage exchange strategy is commonly used in the...

...tain a pre-revision sedimentation rate and CRP to...

...elected circumstances more than one two...


...stage Exchange...

...one stage or direct exchange strategy for t...


...ent Resection...

...t resection arthroplasty may be considere...


...mputation...

...putation should be the last option conside...


...ebridement and retention of the pro...

...YLOCOCCAL PJI...

...6 weeks of a pathogen-specific intrav...

...otal elbow, total shoulder and total ank...

...commended oral companion drugs for rifampin inc...

...loxacin ( A , II )659

...ry companion drugs to be used if in...

..., doxycyline ( C , III )65...

...neration cephalosporins such as cephalexin...

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

...g of outpatient IV antimicrobial thera...

...ite chronic oral antimicrobial suppression with...

...ne is NOT recommended for chronic suppression,...

...boratory monitoring for efficacy and to...

...decision to offer chronic suppressive therapy mus...

...essive therapy is therefore genera...

...JI DUE TO OTHER ORGAN...

...weeks of pathogen-specific intravenous o...

...ow published guidelines for monitoring ou...

...chronic oral antimicrobial suppres...

...esection arthroplasty with or without planned stag...

...eeks of pathogen-specific intravenous...

...ng of outpatient IV antimicrobial t...


PJI following one-stag...

...LOCOCCAL PJI ...

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

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

...cin. ( A , II )659...

...y companion drugs to be used if in vitro susceptib...

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

...oral first generation cephalosporins such...

...rifampin cannot be used due to al...

...guidelines to monitor outpatient IV antim...

...te chronic oral antimicrobial suppression...

...ne is NOT recommended for chronic suppres...

...and laboratory monitoring for effica...

...he decision to offer chronic suppressive thera...

...JI DUE TO OTHER ORGANIS...

...ith 4-6 weeks of pathogen-specific intra...

...low published guidelines for monitoring outpatien...

...ite chronic oral antimicrobial suppre...


...er Amputation...

...-specific antimicrobial therapy until 24-48 h...

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

...ed guidelines for monitoring outpatient IV an...


Figure 2. Management of...


...gure 3. Management of PJI-III - Removal...


...ure 4. Management of PJI-I...


...1. Intravenous or Highly Bioavailable O...


...2. Common Antimicrobials Used for Chronic Ora...


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