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
Diagnosis and Assessme...
...ition of PJI...
...he presence of a sinus tract that communicates...
...purulence surrounding the prosthesis...
...e of acute inflammation as defined by th...
...or more intraoperative cultures or a combi...
...sence of PJI is possible even if the above criter...
...ve Evaluation (Figure 1)...
...JI in patients with any of the following:...
...e patient with a possible PJI should...
...hat should be obtained in the history include th...
...sedimentation rate or C-reactive pro...
...radiograph should be performed in a...
...throcentesis should be performed in all pa...
...sis is also advised in patients wit...
...hrocentesis may not be necessary if in this sit...
...l fluid analysis should include a total cel...
...sis can also be performed if clinically indicat...
...n PJI where the patient is medically stabl...
...lood cultures for aerobic and anaerobic organ...
...udies such as bone scans, leukocyte scans...
...erative Diagnosis Of P...
...ve histopathological examination of peri-pros...
...t least three and optimally five or...
...e (see above), withholding antimicrobial therapy f...
...rative and Intraoperative Diagnosis of PJI...
Treatment
...reatme...
...decision regarding surgical management should...
...onsider for debridement and retention of prosth...
...o do not meet these criteria but for whom a...
...-stage Exchange...
...two-stage exchange strategy is commonly used i...
...ain a pre-revision sedimentation r...
...n selected circumstances more than on...
...ne-stage Exchan...
...ne stage or direct exchange strategy for...
...ermanent Resection...
...ent resection arthroplasty may be considered:...
...putation...
...should be the last option considered but may b...
...ng debridement and retention of the pro...
...LOCOCCAL PJI...
...2-6 weeks of a pathogen-specific intraveno...
...total elbow, total shoulder and to...
...ended oral companion drugs for rifamp...
...acin ( A , II )659...
...condary companion drugs to be used if in...
...nocycline, doxycyline ( C , III )65...
...irst generation cephalosporins such...
...annot be used due to allergy, toxicity or i...
...oring of outpatient IV antimicrobial therap...
...chronic oral antimicrobial suppres...
...mpin alone is NOT recommended for chronic suppress...
...laboratory monitoring for efficacy a...
...ecision to offer chronic suppressive therapy must...
...uppressive therapy is therefore generally reserv...
...JI DUE TO OTHER ORGANIS...
...eeks of pathogen-specific intravenous o...
...low published guidelines for monitoring outpati...
...ronic oral antimicrobial suppression sho...
PJI following resection arthroplasty with or...
...weeks of pathogen-specific intraven...
...nitoring of outpatient IV antimicrobial therapy s...
...ollowing one-stage exc...
STAPHYLOCOCCAL P...
Treat with 2-6 weeks of pathogen-specific...
...l companion drugs for rifampin include...
levofloxacin. ( A ,...
...ry companion drugs to be used if in vi...
..., doxycycline ( B , III )659...
...irst generation cephalosporins such as...
...not be used due to allergy, toxicity...
...ed guidelines to monitor outpatient IV antimic...
...ndefinite chronic oral antimicrobial suppression w...
...alone is NOT recommended for chronic suppressi...
...nical and laboratory monitoring for eff...
...he decision to offer chronic suppressive the...
...TO OTHER ORGANISMS...
...-6 weeks of pathogen-specific intravenous...
...low published guidelines for monitorin...
...chronic oral antimicrobial suppression should...
After Amputat...
...pathogen-specific antimicrobial therapy...
...ks of pathogen-specific intravenous or highly b...
...llow published guidelines for monitoring o...
...2. Management of PJI...
...nagement of PJI-III - Removal of Prosthes...
...re 4. Management of PJI-...
...nous or Highly Bioavailable Oral Antim...
...Antimicrobials Used for Chronic Oral Antim...
...e 3. DrugsHaving trouble viewing tabl...