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 Asse...
...efinition of PJ...
...resence of a sinus tract that communicate...
...purulence surrounding the prosthesis without anoth...
...sence of acute inflammation as defined by the atte...
...or more intraoperative cultures or a com...
...of PJI is possible even if the above cri...
...tive Evaluation (Figure 1)...
...atients with any of the following: ( B , II...
...f the patient with a possible PJI should include...
...tems that should be obtained in the his...
...ation rate or C-reactive protein shou...
...lain radiograph should be performed...
...ostic arthrocentesis should be performe...
...throcentesis is also advised in pati...
...esis may not be necessary if in this si...
...luid analysis should include a total cel...
...crystal analysis can also be perform...
In PJI where the patient is medically...
...for aerobic and anaerobic organism...
...ging studies such as bone scans, leuk...
...tive Diagnosis Of PJI...
...istopathological examination of peri-prost...
At least three and optimally five or six periprost...
...(see above), withholding antimicrobial therapy fo...
...reoperative and Intraoperative Diagnosis of PJI...
Treatment
...reatme...
...cision regarding surgical management should be mad...
...er for debridement and retention of pros...
...ho do not meet these criteria but f...
...stage Exchange...
...exchange strategy is commonly used in the US and...
...e-revision sedimentation rate and CRP to assess...
...d circumstances more than one two-stage excha...
...ne-stage Exchang...
...direct exchange strategy for the tre...
...ermanent Resect...
...manent resection arthroplasty may be...
...putation...
...hould be the last option considered but may be...
...following debridement and retention of th...
...LOCOCCAL PJI...
Treat with 2-6 weeks of a pathogen...
...al elbow, total shoulder and total ankle...
...oral companion drugs for rifampin include cip...
...oxacin ( A , II )659...
...anion drugs to be used if in vitro sus...
...doxycyline ( C , III )659...
...ral first generation cephalosporins such as cepha...
...cannot be used due to allergy, toxicity or int...
...ing of outpatient IV antimicrobial therapy should...
...ronic oral antimicrobial suppression wit...
...fampin alone is NOT recommended for chronic supp...
...linical and laboratory monitoring for efficac...
The decision to offer chronic suppressive...
...sive therapy is therefore generally reserved...
...TO OTHER ORGANISM...
...eeks of pathogen-specific intravenous or highly...
...w published guidelines for monitoring outp...
...definite chronic oral antimicrobial sup...
...I following resection arthroplasty wi...
...hogen-specific intravenous or highly...
...outpatient IV antimicrobial therapy shou...
...ollowing one-stage exc...
...APHYLOCOCCAL PJI ...
...ith 2-6 weeks of pathogen-specific intravenou...
...oral companion drugs for rifampin include c...
levofloxacin. ( A , I...
...nion drugs to be used if in vitro susceptibili...
...doxycycline ( B , III )659...
...first generation cephalosporins su...
...fampin cannot be used due to allergy,...
...d guidelines to monitor outpatient IV...
...ndefinite chronic oral antimicrobial...
...in alone is NOT recommended for chronic sup...
...d laboratory monitoring for efficacy and toxic...
...to offer chronic suppressive therapy must take...
...JI DUE TO OTHER OR...
...-6 weeks of pathogen-specific intravenous or...
...ublished guidelines for monitoring outpa...
...onic oral antimicrobial suppression should...
After Amputation
...gen-specific antimicrobial therapy until 2...
...eeks of pathogen-specific intravenous...
...hed guidelines for monitoring outpa...
...Management of PJI-II...
...e 3. Management of PJI-III - Removal...
...4. Management of PJI-I...
...e 1. Intravenous or Highly Bioavailable Oral An...
...Common Antimicrobials Used for Chronic Oral Antim...
...sHaving trouble viewing table? Expand...