Towards a New Paradigm in the Diagnosis and Treatment of Orthopedic Infections

Abstract

Imagine an office visit of an older, but still poised, oncologist with her orthopedic surgeon. The surgeon must somehow break the news that a prosthetic knee, installed some 10 months previously, must be removed in a two-stage procedure that will leave the lady immobile while an infection is brought under control, and a new knee can be implanted in 3 months. If this frightening specter was an ovarian cancer, the oncologist would ask if the genome of her cancer had been sequenced and whether estrogen receptors were present on her malignant cells, so that a rational treatment strategy could be devised. The surgeon would say that the aspirate he took on the previous visit had grown “Staphylococcus epidermidis,” in small numbers that might be contaminants from the technician’s hands, and that most strains of Staphylococcus epidermidis these days were resistant to methicillin so she had better go on an aminoglycoside until her surgery early next week. And the twenty-first century would have ground to a sickening halt, on the residue of nineteenth century techniques, right there in the surgeons’ office.