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Prosthetic Joint Infections

  • Skin, Soft Tissue, Bone, and Joint Infections (N Safdar, Section Editor)
  • Published:
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Abstract

Prosthetic joint infections represent a major therapeutic challenge for both healthcare providers and patients. This article reviews the predisposing factors, pathogenesis, microbiology, diagnosis, treatment, and prophylaxis of prosthetic joint infection. The most optimal management strategy should be identified on the basis of a number of considerations, including type and duration of infection, antimicrobial susceptibility of the infecting pathogen, condition of infected tissues and bone stock, patient wishes, and functional status.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis. 2003;36(9):1157–61.

    Article  PubMed  Google Scholar 

  2. Blom AW, Brown J, Taylor AH, et al. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86(5):688–91.

    Article  PubMed  CAS  Google Scholar 

  3. Blom AW, Taylor AH, Pattison G, et al. Infection after total hip arthroplasty. The Avon experience. J Bone Joint Surg Br. 2003;85(7):956–9.

    Article  PubMed  CAS  Google Scholar 

  4. Berbari EF, Hanssen AD, Duffy MC, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27(5):1247–54.

    Article  PubMed  CAS  Google Scholar 

  5. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005;87(8):1746–51.

    Article  PubMed  Google Scholar 

  6. Poss R, Thornhill TS, Ewald FC, et al. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res. 1984;(182):117-26.

  7. Kaandorp CJ, Dinant HJ, van de Laar MA, et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56(8):470–5.

    Article  PubMed  CAS  Google Scholar 

  8. Wilson MG, Kelley K, Thornhill TS. Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am. 1990;72(6):878–83.

    PubMed  CAS  Google Scholar 

  9. Bongartz T, Halligan CS, Osmon DR, et al. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum. 2008;59(12):1713–20.

    Article  PubMed  Google Scholar 

  10. Choong PF, Dowsey MM, Carr D, et al. Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampinbased regimen. Acta Orthop. 2007;78(6):755–65.

    Article  PubMed  Google Scholar 

  11. Aslam S, Reitman C, Darouiche RO. Risk factors for subsequent diagnosis of prosthetic joint infection. Infect Control Hosp Epidemiol. 31(3):298-301.

  12. Jamsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91(1):38–47.

    Article  PubMed  Google Scholar 

  13. Ong KL, Kurtz SM, Lau E, et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24(6 Suppl):105–9.

    Article  PubMed  Google Scholar 

  14. Font-Vizcarra L, Tornero E, Bori G, et al. Relationship between intraoperative cultures during hip arthroplasty, obesity, and the risk of early prosthetic joint infection: a prospective study of 428 patients. International J Artif Organs. 2011;34(9):870–5. Epub 2011/11/19.

    Article  CAS  Google Scholar 

  15. Aslam S. Effect of antibacterials on biofilms. Am J Infect Control. 2008;36(10):S175.e9–S175.e11. Epub 2008/12/17.

    Article  Google Scholar 

  16. •• Zimmerli W, Moser C. Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol. 2012;65(2):158–68. Epub 2012/02/09. This article discusses the pathogenesis of PJI in detail, with emphasis on biofilm and its interaction with antimicrobials.

    Article  PubMed  CAS  Google Scholar 

  17. Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357(7):654–63. Epub 2007/08/19.

    Article  PubMed  CAS  Google Scholar 

  18. Peel TN, Cheng AC, Buising KL, Choong PF. Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective? Antimicrob Agents Chemother. 2012;56(5):2386–91. Epub 2012/02/09.

    Article  PubMed  CAS  Google Scholar 

  19. Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res. 2011;469(4):1009–15. Epub 2010/12/17.

    Article  PubMed  Google Scholar 

  20. •• Del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. New England J Med. 2009;361(8):787–94. Epub 2009/08/21. This review article discusses the clinical management of PJI.

    Article  Google Scholar 

  21. Malekzadeh D, Osmon DR, Lahr BD, et al. Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection. Clin Orthop Relat Res. 2010;468(8):2039–45. Epub 2010/04/20.

    Article  PubMed  Google Scholar 

  22. Atkins BL, Athanasou N, Deeks JJ, et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS collaborative study group. J Clin Microbiol. 1998;36(10):2932–9. Epub 1998/09/17.

    PubMed  CAS  Google Scholar 

  23. Hughes JG, Vetter EA, Patel R, et al. Culture with BACTEC Peds Plus/F bottle compared with conventional methods for detection of bacteria in synovial fluid. J Clin Microbiol. 2001;39(12):4468–71. Epub 2001/11/29.

    Article  PubMed  CAS  Google Scholar 

  24. Sorli L, Puig L, Torres-Claramunt R, et al. The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis. J Bone Joint Surg British Vol. 2012;94(2):249–53. Epub 2012/02/11.

    Article  CAS  Google Scholar 

  25. Piper KE, Fernandez-Sampedro M, Steckelberg KE, et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS One. 2010;5(2):e9358. Epub 2010/02/25.

    Article  PubMed  Google Scholar 

  26. Kusuma SK, Ward J, Jacofsky M, et al. What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee? Clin Orthop Relat Res. 2011;469(4):1002–8. Epub 2010/10/14.

    Article  PubMed  Google Scholar 

  27. Bjerkan G, Witso E, Nor A, et al. A comprehensive microbiological evaluation of fifty-four patients undergoing revision surgery due to prosthetic joint loosening. J Med Microbiol. 2012;61(Pt 4):572–81. Epub 2011/12/03.

    Article  PubMed  CAS  Google Scholar 

  28. Esteban J, Alonso-Rodriguez N, Del-Prado G, et al. PCR-hybridization after sonication improves diagnosis of implant-related infection. Acta Orthop. 2012;83(3):299–304. Epub 2012/05/24.

    Article  PubMed  Google Scholar 

  29. Brause BD. Infections with prostheses in bones and joints. In: Gerald M. Mandell JEB, Raphael Dolin, editors. Mandell, Douglas and Bennet’s principles and practice of infectious diseases. sixth ed2005. p. 1332-47.

  30. Karchmer AW. In: Gorbach SLBJ, Blacklow NR, editors. Infections in a Prosthetic Device. Philadelphia: WB Saunders; 1998. p. 1666–78.

    Google Scholar 

  31. El-Ghannam A, Jahed K, Govindaswami M. Resorbable bioactive ceramic for treatment of bone infection. J Biomed Mater Res Part A. 2010;94(1):308–16. Epub 2010/02/27.

    Article  Google Scholar 

  32. Kazemzadeh-Narbat M, Kindrachuk J, Duan K, et al. Antimicrobial peptides on calcium phosphate-coated titanium for the prevention of implant-associated infections. Biomaterials. 2010;31(36):9519–26. Epub 2010/10/26.

    Article  PubMed  CAS  Google Scholar 

  33. Lieberman JR, Callaway GH, Salvati EA, et al. Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res. 1994;301:205–12.

    PubMed  Google Scholar 

  34. McDonald DJ, Fitzgerald Jr RH, Ilstrup DM. Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am. 1989;71(6):828–34.

    PubMed  CAS  Google Scholar 

  35. Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. J Bone Joint Surg Am. 1998;80-A(6):910–22.

    Google Scholar 

  36. Colyer RA, Capello WN. Surgical treatment of the infected hip implant. Two-stage reimplantation with a one-month interval. Clin Orthop Relat Res. 1994;298:75–9.

    PubMed  Google Scholar 

  37. Sanchez-Sotelo J, Berry DJ, Hanssen AD, Cabanela ME. Midterm to long-term followup of staged reimplantation for infected hip arthroplasty. Clin Orthop Relat Res. 2009;467(1):219–24.

    Article  PubMed  Google Scholar 

  38. Masri BA, Panagiotopoulos KP, Greidanus NV, et al. Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty. J Arthroplast. 2007;22(1):72–8.

    Article  Google Scholar 

  39. Bejon P, Berendt A, Atkins BL, et al. Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology. J Antimicrob Chemother.65(3):569-75.

  40. Hanssen AD, Trousdale RT, Osmon DR. Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty. Clin Orthop Relat Res. 1995;321:55–67.

    PubMed  Google Scholar 

  41. Haleem AA, Berry DJ, Hanssen AD. Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res. 2004;428:35–9.

    Article  PubMed  Google Scholar 

  42. Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res. 2011;469(4):985–93. Epub 2010/09/30.

    Article  PubMed  Google Scholar 

  43. Hsieh PH, Huang KC, Lee PC, Lee MS. Two-stage revision of infected hip arthroplasty using an antibiotic-loaded spacer: retrospective comparison between short-term and prolonged antibiotic therapy. J Antimicrob Chemother. 2009;64(2):392–7.

    Article  PubMed  CAS  Google Scholar 

  44. Whittaker JP, Warren RE, Jones RS, Gregson PA. Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection? J Bone Joint Surg British Vol. 2009;91(1):44–51. Epub 2008/12/19.

    Article  CAS  Google Scholar 

  45. Della Valle CJ, Bogner E, Desai P, et al. Analysis of frozen sections of intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection. J Bone Joint Surg Am. 1999;81(5):684–9.

    PubMed  CAS  Google Scholar 

  46. Mont MA, Waldman BJ, Hungerford DS. Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection. A comparison-group study. J Bone Joint Surg Am. 2000;82-A(11):1552–7.

    PubMed  CAS  Google Scholar 

  47. Lonner JH, Siliski JM, Della Valle C, et al. Role of knee aspiration after resection of the infected total knee arthroplasty. Am J Orthop. 2001;30(4):305–9.

    PubMed  CAS  Google Scholar 

  48. Klouche S, Leonard P, Zeller V, et al. Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop & Traumatol, Surg & Res: OTSR. 2012;98(2):144–50. Epub 2012/03/01.

    Article  CAS  Google Scholar 

  49. Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J. Infection control rate of irrigation and debridement for periprosthetic joint infection. Clin Orthop Relat Res. 2011;469(11):3043–8. Epub 2011/05/10.

    Article  PubMed  Google Scholar 

  50. Gardner J, Gioe TJ, Tatman P. Can this prosthesis be saved?: implant salvage attempts in infected primary TKA. Clin Orthop Relat Res. 2011;469(4):970–6. Epub 2010/06/15.

    Article  PubMed  Google Scholar 

  51. Choi HR, von Knoch F, Zurakowski D, et al. Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res. 2011;469(4):961–9. Epub 2010/11/17.

    Article  PubMed  Google Scholar 

  52. Brandt CM, Sistrunk WW, Duffy MC, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis. 1997;24(5):914–9.

    Article  PubMed  CAS  Google Scholar 

  53. Meehan AM, Osmon DR, Duffy MC, et al. Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis. Clin Infect Dis. 2003;36(7):845–9.

    Article  PubMed  CAS  Google Scholar 

  54. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am. 1998;80(9):1306–13.

    PubMed  CAS  Google Scholar 

  55. Schoifet SD, Morrey BF. Treatment of infection after total knee arthroplasty by debridement with retention of the components. J Bone Joint Surg Am. 1990;72(9):1383–90.

    PubMed  CAS  Google Scholar 

  56. Tattevin P, Cremieux AC, Pottier P, et al. Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis. 1999;29(2):292–5.

    Article  PubMed  CAS  Google Scholar 

  57. Teeny SM, Dorr L, Murata G, Conaty P. Treatment of infected total knee arthroplasty. Irrigation and debridement versus two-stage reimplantation. J Arthroplast. 1990;5(1):35–9. Epub 1990/03/01.

    Article  CAS  Google Scholar 

  58. Mont MA, Waldman B, Banerjee C, et al. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplast. 1997;12(4):426–33. Epub 1997/06/01.

    Article  CAS  Google Scholar 

  59. Byren I, Bejon P, Atkins BL, et al. One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother. 2009;63(6):1264–71. Epub 2009/04/02.

    Article  PubMed  CAS  Google Scholar 

  60. Salgado CD, Dash S, Cantey JR, Marculescu CE. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res. 2007;461:48–53. Epub 2007/05/31.

    PubMed  Google Scholar 

  61. Zimmerli W, Widmer AF, Blatter M, et al. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA: J Am Med Assoc. 1998;279(19):1537–41. Epub 1998/05/30.

    Article  CAS  Google Scholar 

  62. Pavoni GL, Giannella M, Falcone M, et al. Conservative medical therapy of prosthetic joint infections: retrospective analysis of an 8-year experience. Clin Microbiol Infect: Off Publ Eur Soc Clin Microbiol Infect Dis. 2004;10(9):831–7. Epub 2004/09/10.

    CAS  Google Scholar 

  63. Rao N, Crossett LS, Sinha RK, Le Frock JL. Long-term suppression of infection in total joint arthroplasty. Clinical orthopaedics and related research. 2003(414):55-60. Epub 2003/09/11.

  64. Widmer AF, Gaechter A, Ochsner PE, Zimmerli W. Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations. Clini Infect Dis: Off Publ Infect Dis Soc Am. 1992;14(6):1251–3. Epub 1992/06/01.

    CAS  Google Scholar 

  65. American Association of Orthopaedic Surgeons: Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasty. 2004 [June 27, 2012]; Available from: http://www6.aaos.org/news/PDFopen/PDFopen.cfm?page_url=http://www.aaos.org/about/papers/advistmt/1027.asp.

  66. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis: Off Publ Infect Dis Soc Am. 2004;38(12):1706–15. Epub 2004/07/01.

    Google Scholar 

  67. American Association of Orthopaedic Surgeons: Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements. 2009 [cited 2012 June 24, 2012]; Available from: http://www.aaos.org/about/papers/advistmt/1033.asp.

  68. Little JW, Jacobson JJ, Lockhart PB. The dental treatment of patients with joint replacements: a position paper from the American Academy of Oral Medicine. J Am Dent Assoc. 2010;141(6):667–71. Epub 2010/06/03.

    PubMed  Google Scholar 

  69. •• Berbari EF, Osmon DR, Carr A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis: Off Publ Infect Dis Soc Am. 2010;50(1):8–16. Epub 2009/12/03. This study showed that dental procedures are not associated with subsequent diagnosis of PJI.

    Google Scholar 

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 W. Arbor Drive, NARF 307, MC 8415, San Diego, CA, 92103, USA

    Saima Aslam

  2. Center for Prostheses Infection, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, 77030, USA

    Rabih O. Darouiche

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  1. Saima Aslam
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  2. Rabih O. Darouiche
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Correspondence to Saima Aslam.

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Aslam, S., Darouiche, R.O. Prosthetic Joint Infections. Curr Infect Dis Rep 14, 551–557 (2012). https://doi.org/10.1007/s11908-012-0284-2

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