Management and Prevention of Prosthetic Joint Infection
Section snippets
Pathogenesis and risk factors
PJIs are generally classified according to the timing after surgery: early-onset infection occurs within 3 months after arthroplasty, delayed-onset infection within 3 to 24 months, and late-onset infection after 24 months3; the distribution of patients presenting within each category is approximately equal. As with other surgical site infections (SSIs), PJIs occur most commonly because of contamination of the surgical wound with locally introduced microorganisms.4 Therefore, anything that
Microbiology
Almost any microorganism can be associated with PJI, but staphylococci (coagulase-negative staphylococci and S aureus) are the principal causative agents, accounting for more than half of all PJIs.3, 9 Other gram-positive and gram-negative bacilli each represent about 20% to 25% of infections, and anaerobes, including Propionibacterium acnes, account for another 10%. Polymicrobial infection is reported in 10% to 20% of PJIs. In a retrospective series of polymicrobial PJIs, the most frequently
Clinical presentation and diagnosis
Clinical manifestations of PJI are determined by several factors, including host characteristics, the route of infection, and associated microorganisms. The presentation can vary, ranging from a chronic indolent course characterized only by progressive joint pain to a fulminant septic arthritis; however, diagnosis is not always clear-cut because there are many noninfectious causes of prosthesis failure.
Patients with early-onset infection are more likely to have classic signs of inflammation and
Treatment
The ultimate goal of PJI treatment is to achieve a functional and pain-free joint; the approach requires a combination of medical and surgical therapies. Although treatment with antimicrobials alone is generally inadequate, patient preferences and the potential morbidity of further surgical intervention must be carefully considered. Although the most predictably effective approach involves removal of all foreign materials, patients who are unable or unwilling to undergo additional surgery can
Prevention
The general principles of SSI prevention apply to decreasing the risk of PJI.46 Procedure-related prevention focuses on reducing microbial inoculum and preventing contamination of the surgical site. Specific strategies include preparation of the surgical site with an appropriate antiseptic agent, hand scrubbing and use of appropriate attire by surgical staff, sterilization and disinfection of equipment, minimizing traffic in the operating room, and use of appropriate ventilation systems.49
Summary
PJI can result in significant morbidity, especially in older adults with underlying functional impairment. Diagnosis of PJI is challenging and often cannot be firmly established until the prosthesis is removed. Management of PJI often requires removal of the prosthesis combined with an extended duration of antimicrobial treatment. Prevention of PJI requires a multifaceted approach, including perioperative antimicrobial prophylaxis. Related prevention measures that remain controversial include
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Cited by (40)
Comparing the use of preformed vs hand-made antibiotic spacer cement in two stages revision of hip periprosthetic infection
2020, Journal of Clinical Orthopaedics and TraumaCitation Excerpt :Due to the change in the profile of antibiotic resistant bacteria, the prevention and the treatment of primary THA infections has become even more difficult.1,2 The incidence of prosthetic joint infections (PJI) varies depending on the joint involved; according to literature the rate of arthroplasties becoming infected is on the one hand 1.7% for primary and 3.2% for non-primary hip arthroplasties2; on the other hand the incidence is 5% of patients under hip or knee prosthesis.3 Although if a correct and timely microbiological diagnosis of infection is done within 4 weeks, it could be possible to follow a conservative approach on the prosthesis, due to microorganisms are not yet organized in biofilms.1
Nanomaterials for medical applications and their antimicrobial advantages
2019, Materials for Biomedical Engineering: Bioactive Materials for Antimicrobial, Anticancer, and Gene TherapyRisk factors for health care–associated infections: From better knowledge to better prevention
2017, American Journal of Infection ControlPyogenic arthritis of native joints in non-intravenous drug users: A detailed analysis of 268 cases attended in a tertiary hospital over a 22-year period
2015, Seminars in Arthritis and RheumatismFactors related to outcome of early and delayed prosthetic joint infections
2015, Journal of InfectionCitation Excerpt :The patients tolerating rifampin throughout the treatment period reported the best outcome (43/47 vs 17/30; X2 = 10.9, RR 1.6, 95% CI 1.17–2.23; p = 0.0001). Infection remains a severe complication of prosthetic joint implant surgery and its management requires both surgical and antibiotic treatments to obtain the highest cure rate and reduce the disability period.22 In our study, degenerative disease of the joint was the main reason for the prosthetic implant, which was frequently performed in patients in the middle-late ages with co-morbidities.
The authors have nothing to disclose. There was no outside support for this work.