Surgical treatment of prosthetic joint infections of the. The management of prosthetic joint infection requires preoperative assessment of risk factors and the treatment options be individualized with a team approach between orthopaedic surgeon and musculoskeletal infectious disease specialist. Intricate interactions between the pathogen, the host, and the implant can result in pjis which are not only. Although highlevel evidence may support some of these practices, many are based on little to no scientific foundation. Prosthetic joint infection pji is a tremendous burden for individual patients as well as the global health care industry. Backgrounda major obstacle for the treatment of prosthetic joint infection pji is the identification of the underlying causative organism. The infection threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient due to long term hospitalization and high cost. Oral versus intravenous antibiotic treatment for bone and. Joint and bone infections john s axford abstract all microorganisms can cause joint and bone disease, but bacterial arthritis is more common and the most potentially dangerous and destructive. Prosthetic joint infection pji, also referred to as periprosthetic infection, is defined as infection involving the joint prosthesis and adjacent tissue.
The process engaged a large number of individuals from many countries and from various specialties to agree on what is known about pji based on available. The challenge in the management of pji is the persistence of microorganisms on the implant surface in the form of biofilm. Chronic infection generally has a more subtle presentation, with pain alone, and it is often accompanied by loosening of the pros. Periprosthetic joint infection bhaveen h kapadia, richard a berg, jacqueline a daley, jan fritz, anil bhave, michael a mont periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. The main risk factors to periprosthetic joint infections pjis are advanced age. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. Jnt joint or bursa infection not for use as organspace ssi after hpro or kpro procedures joint or bursa infections must meet at least one of the following criteria. To address this, the international consensus meeting on periprosthetic joint infection was organized.
Its also one of the most concerning, since delaying treatment can lead to impaired joint function, among other serious health problems. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Between 8% and 22% of patients who undergo tja have diabetes,25 and about one third have undiagnosed hyperglycemia. There are multiple known risk factors for periprosthetic joint infection, that can be divided into several groups, both patientrelated and surgeryrelated 1. Fungal microorganisms are still a rare cause of bone and joint infections. Prosthetic joint infection pji is the most feared complication of arthroplasties. Prosthetic joint infection pji is a feared complication of arthroplasty. While infection of a joint prosthesis is uncommon, it is the most severe complication that can occur after prosthetic implantation 12.
Infection is considered to be the most devastating of prosthesisrelated complications, leading to prolonged hospitalization, repeated surgical intervention, and even definitive loss of the implant. Pathophysiology of osteomyelitis blood flow highly vascularized developing vasculature sluggish flow. Periprosthetic joint infection is probably the most devastating complication of joint replacement surgery. A new definition for periprosthetic joint infection created. The associated morbidity can be devastating to patients and costs the national health service an estimated. Identification of the causal microbial factor is of paramount importance for the successful treatment. Advances in the understanding of the epidemiology, diagnosis, management, and prevention of pji over the last quarter century have led to improvement in outcomes for this challenging infection. Surgical treatment of prosthetic joint infections of the hip. Microorganisms can cause disease by active infection, reaction to the organism and inflammation induced by auto activation of the immune system. Apr 18, 2008 periprosthetic joint infection is one of the most challenging complications of joint arthroplasty. Joint replacement is a highly effective intervention that signi. Implantation of joint prostheses is becoming increasingly common, especially for the hip and knee. The infection resides in synovial or periarticular tissues and is usually bacterialin younger adults, frequently neisseria gonorrhoeae. Periprosthetic joint infection pji accounts for 25% of failed tkas and 15% of failed thas 2, 3.
Type iii acute infection in a wellfunctioning joint. Incidence varies substantially across medical facilities. We identified current risk factors of periprosthetic joint infection after modern joint arthroplasty, and determined the incidence and timing of periprosthetic joint infection. We report a new case of knee prosthetic joint infection due to candida albicans in a patient with a previous twostage right knee arthroplasty for septic arthritis due to s. Bacterial joint inflammation is a serious and painful infection in a joint. Goals for management of prosthetic joint infection pji include alleviation of symptoms and restoration of function 15.
Infection site was the knee in 38 patients and hip in 36. A single reference test for diagnosing this worrisome complication has been shifting investigators over the last years. Periprosthetic joint infection is one of the most challenging complications of joint arthroplasty. Diagnosis and management of prosthetic joint infection.
Acute infectious arthritis is a joint infection that evolves over hours or days. Periprosthetic joint infection linkedin slideshare. Optimal management requires multiple surgical procedures with one or more hospitalizations, and 4 to 6. May 06, 2020 prosthetic joint infection pji is the most feared complication of arthroplasties. Development of multidisciplinary expertise lags behind the major expansion in the use of complex orthopaedic devices over. Infectionssuch as osteomyelitis, a bacterial infection in the bones, and septic arthritis, a bacterial or fungal infection in the jointscan become chronic conditions without prompt treatment. Sep 01, 2010 periprosthetic joint infection has emerged as the most common cause for failure following total knee arthroplasty tka. Oral versus intravenous antibiotics for bone and joint infection oviva was a multicenter, openlabel, parallelgroup, randomized, controlled noninferiority trial. The main risk factors to periprosthetic joint infections pjis are advanced age, malnutrition. Periprosthetic joint infection pji accounts for 25% of failed kneearthroplasties6and15%offailedhiparthroplasties7.
Chronic suppression with oral antibiotics increased the infectionfree prosthetic survival rate following surgical treatment for periprosthetic joint infection. For patients with a history of complications associated with their joint replacement surgery who are undergoing dental procedures. Issues related to the epidemiology, clinical manifestations, diagnosis, and prevention of pjis are discussed separately. Oral versus intravenous antibiotics for bone and joint. Cdcnhsn surveillance definitions for specific types of. Inflammatory blood laboratory levels as markers of prosthetic joint infection. The aim of this study is to compare the sonication fluid cultures derived from joint prosthetic components with the respective periprosthetic tissue cultures. Periprosthetic joint infection pji is a serious complication occurring in 1% to 2% of primary arthroplasties, which is associated with high morbidity and need for complex interdisciplinary treatment strategies.
However, nongonococcal bacterial infections can also occur and can rapidly destroy joint structures. The risk of septic loosening is estimated to be between 0. Additionally, finding new and more rapid methods for. Dec 21, 2015 bone and joint infection in adults arises most commonly as a complication of joint replacement surgery, fracture fixation and diabetic foot infection. Forty patients were female and mean age at diagnosis was 65. More than 25% of revisions are attributed to these infections, which are expected to increase. Prosthetic joint infection pji is a serious complication of prosthetic joint implantation. Population incidence of pji in developed countries has been estimated in the range of 12% in the first two postoperative years, with lower rates thereafter. Infections associated with other implanted orthopedic devices, such as pins and rods, will not be specifically discussed, but similar principles may apply. International consensus on periprosthetic joint infection. Bacteria, viruses, or fungi may spread through the bloodstream or from a nearby infection into a joint, causing infection. Feb, 2015 periprosthetic joint infection pji accounts for 25% of failed tkas and 15% of failed thas 2, 3.
Oct 24, 20 the consensus process at the international consensus on periprosthetic joint infection was designed specifically to address as many issues surrounding the management of pji as possible. Total hip joint replacement offers dramatic improvement in the quality of life but periprosthetic joint infection pji is the most devastating complication of this procedure. Management of pjis discusses periprosthetic joint infection pji, a fairly rare occurrence that is nonetheless one of the most serious complications in joint replacement surgery. Acute infectious arthritis merck manuals professional edition. Periprosthetic joint infection pji is the most severe complication, following joint arthroplasty. Intricate interactions between the pathogen, the host, and the implant can result in pjis which are not only physically devastating for the. Introduction periprosthetic joint infections pjis remain a challenge for orthopaedic surgeons to treat, and remain a leading cause of failure of both primary and revision total joint arthroplasty tja. No risk factors for candidal infection were found in 25 patients. The consensus process at the international consensus on periprosthetic joint infection was designed specifically to address as many issues surrounding the management of pji as possible. Patient has organisms identified from joint fluid or synovial biopsy by culture or nonculture based.
This results in wide variation across the globe for prevention and management of pji. A significant increase is expected in the number of these infections observed during the coming decades. Its diagnosis remains a serious clinical challenge because of the low specificity of clinical signs and laboratorial tests. Diagnosis and treatment options for periprosthetic joint.
Current standard of care in most uk centres includes a prolonged course 46 weeks of intravenous. Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. When diseasecarrying bacteria enter the body and spread through the bloodstream, bones and joints can become infected. Nov 11, 2016 type iii acute infection in a wellfunctioning joint. A significant increase is expected in the number of these. Infectious arthritis is infection in the fluid and tissues of a joint usually caused by bacteria but occasionally by viruses or fungi. Aug 31, 2015 periprosthetic joint infection, post tkr infection slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Definition of periprosthetic joint infection volume 29, issue, 7, pages. Hip and knee arthroplasties are successful elective surgical procedures, with greater than 95% survivorship at 10year followup. Proceedings of the international consensus meeting on.
Management of periprosthetic joint infections pjis. Prosthetic joint infections virginia commonwealth university. Prosthetic joint infections infectious disease and. Definition of periprosthetic joint infection article pdf available in the journal of arthroplasty 297. Bacteria can get into your joint and cause rapid cartilage. If you continue browsing the site, you agree to the use of cookies on this website. In the case of a painful tja it is mandatory to distinguish between aseptic and septic causes of the failure. Chronic suppression of periprosthetic joint infections. In general, for patients with prosthetic joint implants, prophylactic antibiotics are not. Infectious arthritis bone, joint, and muscle disorders.