Prosthetic Joint Infection Diagnosis

Common Causes Hip and Knee Arthroplasty Infection

January 2010

It is important to accurately diagnose prosthetic joint infection as its management differs from the management of other causes of arthroplasty failure.  The goal of treatment is to cure infection, prevent recurrence, and achieve a pain-free, functional joint.  This can best be achieved by a multidisciplinary team including an orthopaedic surgeon, clinical microbiologist, and infectious disease specialist.

Antimicrobial agents alone, without surgical intervention, ultimately usually fail.  The quality of surgical debridement is critical.  A general approach to surgical management is outlined, although different centers and surgeons may use slightly different strategies. Chronic infections require resection arthroplasty either as a one-stage, with removal and reimplantation of the prosthesis during the same surgical procedure, or a two-stage, with removal of the prosthesis and systemic antimicrobial agents with subsequent prosthesis reimplantation exchange.  Patients with symptoms of prosthetic joint infection for fewer than three weeks, who present with early postoperative or hematogenous infection, and who have a well-fixed, functioning prosthesis, without a sinus tract, and with appropriate microbiology represent a select group potentially amenable to debridement and retention of the prosthesis.  When unacceptable function is anticipated following surgery or the infection has been refractory to multiple surgical attempts at cure, resection arthroplasty with creation of a pseudarthrosis for hips (a Girdlestone procedure) or arthrodesis for knees may be considered.  If the patient is not a surgical candidate, antimicrobial suppression may be considered; this approach is unlikely to cure infection, so antimicrobial agents are often continued indefinitely.

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Jump to section:

• Introduction
• Total Hip and Knee Replacement Procedures United States 1990-2006
• Body Diagram
• Prosthetic Hip and Knee Infections United States 1990-2004
• Surgical Management of Prosthetic Hip or Knee Infection
• Common Causes Hip and Knee Arthroplasty Infection
• Unusual Causes of Prosthetic Joint Infection³
• Diagram
• Criteria for Diagnosis of Prosthetic Joint Infection
• Prosthetic Joint Infection Clinical Presentation
• C-Reactive Protein Erythrocyte Sedimentation Rate
• C-Reactive Protein Erythrocyte Sedimentation Rate
• Images
• ¹⁸F-fluoro-2-deoxyglucose Positron Emission Tomography/Computed Tomography Increased Activity Around the Bone-Prosthesis Interface
• Synovial Fluid Leukocyte/Differential Prosthetic Knee
• Studies of Intrasurgical Frozen-Section Histopathologic Findings of Acute Inflammation in Prosthetic Joint Infection Diagnosis
• Prospective Vortexing/Sonication Clinical Study Hip or Knee Implants⁶
• Staphylococcus epidermidis Biofilm on Polycarbonate Coupons Scanning Electron Microscopy
• Periprosthetic Tissue and Sonicate Fluid Culture
• Prospective Vortexing/Sonication Clinical Study Hip or Knee Implants⁶
• Definition of Prosthetic Hip and Knee Infection
• Number of Microorganisms Detected by Sonicate Fluid Culture
• Results Prosthetic Hip or Knee Infection
• Effect of Preoperative Antimicrobial Therapy on Culture Sensitivity in Patients with Prosthetic Hip or Knee Infection
• Diagram
• Prospective Clinical Study Shoulder Implants
• Prospective Clinical Study Shoulder Implants
• Definition of Definite Prosthetic Shoulder Infection
• Prospective Clinical Study Shoulder Implants
• Shoulder Arthroplasty Infection
• Acknowledgments
• References
• Questions?
• Disclosure