Periprosthetic infections after total hip and knee arthroplasty--a review (original) (raw)
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Periprosthetic Joint Infection: The Incidence, Timing, and Predisposing Factors
Clinical Orthopaedics and Related Research, 2008
Periprosthetic joint infection is one of the most challenging complications of joint arthroplasty. We identified current risk factors of periprosthetic joint infection after modern joint arthroplasty, and determined the incidence and timing of periprosthetic joint infection. We reviewed prospectively collected data from our database on 9245 patients undergoing primary hip or knee arthroplasty between January 2001 and April 2006. Periprosthetic joint infections developed in 63 patients (0.7%). Sixty-five percent of periprosthetic joint infections developed within the first year of the index arthroplasty. The infecting organism was isolated in 57 of 63 cases (91%). The most common organisms identified were Staphylococcus aureus and Staphylococcus epidermidis. We identified the following independent predictors for periprosthetic joint infection: higher American Society of Anesthesiologists score, morbid obesity, bilateral arthroplasty, knee arthroplasty, allogenic transfusion, postoperative atrial fibrillation, myocardial infarction, urinary tract infection, and longer hospitalization. This study confirmed some previously implicated factors and identified new variables that predispose patients to periprosthetic joint infection. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Open Forum Infectious Diseases, 2020
Background. Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. Methods. The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. Results. We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and <7 days of symptoms; 351, 45%), followed by early (≤30 days postimplantation; 196, 25%) and chronic (>30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). Conclusions. In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials. Keywords. arthroplasty infection; artificial joint infection; periprosthetic jo int infection. Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty, resulting in pain, suffering, impaired mobility, prolonged hospitalization, broad-spectrum antibiotic therapy, and societal and economic costs [1-3]. Although arthroplasty revision operations performed for infection have progressively increased [4], estimates from arthroplasty registry data or infection control surveillance may underestimate the true incidence of PJI [5, 6]. Unlike early postoperative or chronic low-grade infections, these data sources do not reliably capture late acute PJI (LA-PJI), which may not be
BMC Infectious Diseases
Background Periprosthetic joint infections (PJIs) represent one of the most serious complications associated with joint replacement surgeries, a complication also of modern orthopedic surgery despite the efforts that occurred in this field. Frequently PJIs lead to prolonged morbidity, increased costs and mortality. Methods We are conducting a single-center observational cohort ongoing study in the Academic Emergency Hospital Sibiu, Romania, study in which sonication of the retrieved and as a rapid method of bacteria detection, molecular identification of bacteria by 16S rRNA beacon-based fluorescent in situ hybridization (bbFISH) are used. Results A total of 61 patients were enrolled in this study. The diagnosis of aseptic loosening was established in 30 cases (49.1%) and the diagnosis of periprosthetic joint infection was established at 31 patients (50.8%). The mean follow-up period in the subgroup of patients diagnosed with periprosthetic joint infections was 36.06 ± 12.59 months ...
Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection
The Journal of Arthroplasty, 2014
Question 1A: What are the significant risk factors for development of surgical site infection (SSI) or periprosthetic joint infection (PJI) after elective total joint arthroplasty (TJA)? Consensus: Active infection of the arthritic joint (septic arthritis), presence of septicemia, and/or presence of active local cutaneous, subcutaneous, or deep tissue infection are all significant risk factors predisposing patients to SSI or PJI and are contraindication to undertaking elective TJA.
Diagnostic value of preoperative blood parameters in periprosthetic joint infections
Journal of Medicine and Palliative Care
Aim: Diagnosis of periprosthetic joint infection (PJI) is not easy and it is made by presenting of combined findings rather than a single finding. The aim of this study is to investigate the role of blood parameters in diagnosing PJI. Material and Method: Revisions of total knee replacement and total hip replacement operated by the same surgeon between 2008 and 2018 were included in this study. Preoperative blood parameters of the patients were recorded. 69 primary arthroplasty patients with similar demographic characteristics to the patients were also included as the control group. Results: 214 arthroplasty patients, 79.0% of whom were female (n=169), were included in this study. The patients were divided into 3 groups; 32.2% were primary arthroplasty, 36.9% were aseptic revision arthroplasty, and 30.8% were septic revision arthroplasty. There was no difference between the three groups in terms of demographic characteristics. In pairwise comparisons, preoperative erythrocyte sedime...
Optimal diagnosis, prevention, and management of periprosthetic joint infection
Orthopedic Research and Reviews, 2015
The pace of the aging population is steadily rising worldwide with a parallel increase in the demand for joint replacement procedures. With the increasing number of patients undergoing arthroplasty, there is also an increased risk for arthroplasty infection that may lead to severe complications, poorer outcome, and substantial extra costs for health care systems. Current rates of prosthetic joint infection are not dramatically different from the 1960s or 1970s, but some general principles are now better defined, and their management has been studied extensively during the past decades, thus resulting in a change in clinical practice. The purpose of this review is to summarize important principles of prosthetic joint infection to guide the clinician and to contribute to the optimal diagnosis, prevention, and management of periprosthetic joint infections.
Periprosthetic joint infections
Interdisciplinary perspectives on infectious diseases, 2013
Implantation of joint prostheses is becoming increasingly common, especially for the hip and knee. Infection is considered to be the most devastating of prosthesis-related complications, leading to prolonged hospitalization, repeated surgical intervention, and even definitive loss of the implant. The main risk factors to periprosthetic joint infections (PJIs) are advanced age, malnutrition, obesity, diabetes mellitus, HIV infection at an advanced stage, presence of distant infectious foci, and antecedents of arthroscopy or infection in previous arthroplasty. Joint prostheses can become infected through three different routes: direct implantation, hematogenic infection, and reactivation of latent infection. Gram-positive bacteria predominate in cases of PJI, mainly Staphylococcus aureus and Staphylococcus epidermidis. PJIs present characteristic signs that can be divided into acute and chronic manifestations. The main imaging method used in diagnosing joint prosthesis infections is X...
Intraoperative Purulence Is Not Reliable for Diagnosing Periprosthetic Joint Infection
The Journal of arthroplasty, 2015
Purulence, defined as presence of pus, is based on subjective interpretation yet has been considered a definite sign of periprosthetic joint infection (PJI). 583 patients undergoing revision arthroplasty due to presumed PJI were retrospectively studied. PJI definition was independent of purulence, based on the definition of Musculoskeletal Infection Society recently modified by International Consensus Group on PJI. 498 patients fulfilled the criteria for definite PJI and 59 patients were deemed as aseptic. Purulence had sensitivity, specificity, positive and negative predictive values of 0.82, 0.32, 0.91, and 0.17, respectively. Purulence was not correlated with higher culture positivity yet was associated with higher synovial WBC counts (mean of 34.8 versus 5.2×10(3)/μL in patients without purulence [P<0.001]). In the absence of objective definition for purulence and in light of its inadequate test characteristics compared to a multi-criteria definition, purulence cannot serve a...
Archives of Orthopaedic and Trauma Surgery
Introduction Periprosthetic joint infections (PJI) following unicompartmental knee arthroplasties (UKAs) will increase. The aim of this review is to evaluate current evidence regarding treatment options, complications, clinical and radiological outcomes of PJI management in UKAs. Methods A systematic review of English literature was performed. Retrospective and prospective studies providing treatment options, complications, clinical and radiological outcomes of PJI following UKAs were included. PJI type, treatment, survival rate with no reoperation for infection and survival rate with no reoperation for any cause were evaluated. Results Eleven articles were included. Three studies focusing on PJI following UKA (45 cases) report a survival rate with no reoperation for infection of 68.9% and a survival rate with no reoperation for any cause of 48.9%. Eight articles concerning UKA failure modes (28 cases) overestimate survival rate with no reoperation for infection (88.9%) and survival...
New trends for diagnosis and treatment of infected total knee arthroplasty
The Journal of Orthopaedics Trauma Surgery and Related Research, 2017
Periprosthetic joint infection (PJI) is a severe complication after total knee arthroplasty (TKA), occurring in approximately 0.3% to 3% of all cases. With growing populations and increasing age, this kind of pathology is worldwide growing its social and economic effects. Many risk factors have been identified but a proper and accurate diagnosis and choice of treatment seem to be characterized by an enormous evolution. Diagnostic features such as clinical and radiological elements are loosening their predictive value. New biomarkers and molecular elements seem to be more precise and accurate in confirming PJI. Anyway, lots of them are still under study. About treatments, decisions of surgeons should not be related to their experience or preference, but every choice should have proper indications. Double-stage treatments should be practiced only in few conditions. Cheaper management such as irrigation or single-stage surgery can be considered for several conditions.