Current concepts in the management of prosthetic joint infection

Abstract

Prosthetic joint infection (PJI) is a serious complication of arthroplasty that is associated with significant mortality, morbidity and costs. PJI is difficult to cure because causative bacteria form and persist in biofilm adherent to the prosthesis surface. PJI can be classified into early, delayed or late according to the time of onset after insertion of the prosthesis, and this classification can help determine pathogenesis and appropriate management. Traditional treatment has been with prolonged intravenous antibiotics and prosthesis exchange, which has been successful in treating infection but is technically difficult and has high rates of associated morbidity. On the basis of in vitro and animal studies, interest has turned to the use of antimicrobials that are particularly active against biofilm-associated bacteria. Recent clinical evidence shows success in more than 77% of early PJI with surgical debridement, retention of prosthesis and the use of rifampicin-based combinations for staphylococcal PJI. Fluoroquinolones are preferred for Gram-negative PJI. Optimal antimicrobial treatment duration and the management of polymicrobial, enterococcal, fungal and culture-negative infections are still yet to be defined but will become more clear as the results of current research comes to hand.

Características microbiológicas y patrones de resistencia en infecciones de prótesis articular en un hospital de referencia

“…El número de aflojamientos asépticos e IPA que nosotros encontramos fue mucho más alto con respecto a las cifras antes mencionadas, siendo la segunda la más frecuente, ya que un poco más de la mitad de los pacientes a los que se les retiró la prótesis articular fue por presentar infección. La IPA es de las complicaciones más serias y catastróficas, debido a que la mayoría de los casos suelen sufrir secuelas físicas irreversibles; además de que su tratamiento genera elevados costos económicos a los sistemas de salud 14 .…”

The implant infection paradox: why do some succeed when others fail? Opinion and discussion paper

“…Early infection in joint arthroplasties is often associated with bacterial contamination during surgical implantation. However, microorganisms can remain dormant on an implant surface for several years before they cause infection resulting in failure (Aboltins et al, 2014). Equally so, the second most common route of infection through haematological spreading from infection elsewhere in the body, can cause clinical signs of infection any time after implantation.…”

Management of Acute Hematogenous Infection Following Total Knee Arthroplasty: A Case Series of 11 Patients

“…In the published literature, prosthetic joint infections (PJI) are classified into three categories (early, delayed, or late), according to the infection occurrence after insertion of the prosthesis, and this classification can help determine pathogenesis and appropriate management. Acute hematogenous infection is rare in the early PJIs that occur in patients after TKA.…”