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Diagnosis and Management of Prosthetic Joint Infection

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Perioperative Management of Patients with Rheumatic Disease

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Abstract

Joint arthroplasty has become commonplace in the United States, with more than 1,000,000 performed per annum. Infection is one of the most feared complications of this procedure, occurring in 0.5–2.0% of episodes, as reported by Matthews et al. (BMJ 338:b1773, 2009). The estimated cost of diagnosis and treatment of prosthetic joint infection (PJI) is $30,000–50,000 per episode, as reported by Matthews et al. (BMJ 338:b1773, 2009). Early recognition and effective management can help minimize the morbidity and cost of this feared complication.

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References

  1. Matthews PC, Berendt AR, McNally MA, Byren I. Diagnosis and management of prosthetic joint infection. BMJ. 2009;338:b1773.

    Article  PubMed  Google Scholar 

  2. 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 

  3. Levy PY, Fenollar F, Stein A, et al. Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis. 2008;46(12):1884–6.

    Article  PubMed  Google Scholar 

  4. Azzam K, Parvizi J, Jungkind D, et al. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am. 2009;91 Suppl 6:142–9.

    Article  PubMed  Google Scholar 

  5. Marculescu CE, Berbari EF, Cockerill 3rd FR, Osmon DR. Fungi, mycobacteria, zoonotic and other organisms in prosthetic joint infection. Clin Orthop Relat Res. 2006;451:64–72.

    Article  PubMed  Google Scholar 

  6. Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Osmon DR. Prosthetic joint infection due to Mycobacterium tuberculosis: a case series and review of the literature. Am J Orthop (Belle Mead NJ). 1998;27(3):219–27.

    CAS  Google Scholar 

  7. Marculescu CE, Cantey JR. Polymicrobial prosthetic joint infections: risk factors and outcome. Clin Orthop Relat Res. 2008;466(6):1397–404.

    Article  PubMed  Google Scholar 

  8. Berbari EF, Marculescu C, Sia I, et al. Culture-negative prosthetic joint infection. Clin Infect Dis. 2007;45(9):1113–9.

    Article  PubMed  Google Scholar 

  9. Piper KE, Jacobson MJ, Cofield RH, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. 2009;47(6):1878–84.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92(11):2102–9.

    Article  PubMed  Google Scholar 

  12. Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117(8):556–62.

    Article  PubMed  Google Scholar 

  13. Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88 Suppl 4:138–47.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. Fink B, Makowiak C, Fuerst M, Berger I, Schafer P, Frommelt L. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br. 2008;90(7):874–8.

    Article  PubMed  CAS  Google Scholar 

  17. Sampedro MF, Patel R. Infections associated with long-term prosthetic devices. Infect Dis Clin North Am. 2007;21(3):785–819.

    Article  PubMed  Google Scholar 

  18. Reinartz P, Mumme T, Hermanns B, et al. Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br. 2005;87(4):465–70.

    Article  PubMed  CAS  Google Scholar 

  19. 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.

    PubMed  CAS  Google Scholar 

  20. Della Valle CJ, Scher DM, Kim YH, et al. The role of intraoperative gram stain in revision total joint arthroplasty. J Arthroplasty. 1999;14(4):500–4.

    Article  PubMed  CAS  Google Scholar 

  21. Ko PS, Ip D, Chow KP, Cheung F, Lee OB, Lam JJ. The role of intraoperative frozen section in decision making in revision hip and knee arthroplasties in a local community hospital. J Arthroplasty. 2005;20(2):189–95.

    Article  PubMed  Google Scholar 

  22. Wong YC, Lee QJ, Wai YL, Ng WF. Intraoperative frozen section for detecting active infection in failed hip and knee arthroplasties. J Arthroplasty. 2005;20(8):1015–20.

    Article  PubMed  Google Scholar 

  23. American Academy of Orthopedic Surgeons. The diagnosis of periprosthetic infections of the hip and knee: guideline and evidence report. http://www.aaos.org/research/guidelines/PJIguideline.pdf (2010). Accessed 30 Sept 2010.

  24. Barrack RL, Aggarwal A, Burnett RS, et al. The fate of the unexpected positive intraoperative cultures after revision total knee arthroplasty. J Arthroplasty. 2007;22(6 Suppl 2):94–9.

    Article  PubMed  Google Scholar 

  25. Ghanem E, Parvizi J, Clohisy J, Burnett S, Sharkey PF, Barrack R. Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection. Clin Orthop Relat Res. 2007;461:44–7.

    PubMed  Google Scholar 

  26. Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am. 2006;88(4):869–82.

    Article  PubMed  Google Scholar 

  27. Kobayashi H, Oethinger M, Tuohy MJ, Hall GS, Bauer TW. Distinction between intact and antibiotic-inactivated bacteria by real-time PCR after treatment with propidium monoazide. J Orthop Res. 2010;28(9):1245–51.

    Article  PubMed  CAS  Google Scholar 

  28. Azzam KA, Seeley M, Ghanem E, Austin MS, Purtill JJ, Parvizi J. Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty. 2010;25:1022–7.

    Article  PubMed  Google Scholar 

  29. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;42(4):471–8.

    Article  PubMed  CAS  Google Scholar 

  30. Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty. 2009;24(6 Suppl):101–4.

    Article  PubMed  Google Scholar 

  31. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-body infection (FBI) study group. JAMA. 1998;279(19):1537–41.

    Article  PubMed  CAS  Google Scholar 

  32. El Helou OC, Berbari EF, Lahr BD, et al. Efficacy and safety of rifampin containing regimen for staphylococcal prosthetic joint infections treated with debridement and retention. Eur J Clin Microbiol Infect Dis. 2010;29(8):961–7.

    Article  PubMed  Google Scholar 

  33. Berbari EF, Osmon DR, Duffy MC, et al. Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis. 2006;42(2):216–23.

    Article  PubMed  Google Scholar 

  34. Hanssen AD, Osmon DR. Assessment of patient selection criteria for treatment of the infected hip arthroplasty. Clin Orthop Relat Res. 2000;381:91–100.

    Article  PubMed  Google Scholar 

  35. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am. 2007;89(4):871–82.

    Article  PubMed  Google Scholar 

  36. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351(16):1645–54.

    Article  PubMed  CAS  Google Scholar 

  37. Ghanem E, Antoci Jr V, Pulido L, Joshi A, Hozack W, Parvizi J. The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty. Int J Infect Dis. 2009;13(6):e444–9.

    Article  PubMed  CAS  Google Scholar 

  38. Kurd MF, Ghanem E, Steinbrecher J, Parvizi J. Two-stage exchange knee arthroplasty: does resistance of the infecting organism influence the outcome? Clin Orthop Relat Res. 2010;468(8):2060–6.

    Article  PubMed  Google Scholar 

  39. Mittal Y, Fehring TK, Hanssen A, Marculescu C, Odum SM, Osmon D. Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am. 2007;89(6):1227–31.

    Article  PubMed  Google Scholar 

  40. Phelan DM, Osmon DR, Keating MR, Hanssen AD. Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature. Clin Infect Dis. 2002;34(7):930–8.

    Article  PubMed  Google Scholar 

  41. Pagnano MW, Trousdale RT, Hanssen AD. Outcome after reinfection following reimplantation hip arthroplasty. Clin Orthop Relat Res. 1997;338:192–204.

    Article  PubMed  Google Scholar 

  42. 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 

  43. 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 

  44. Rao N, Crossett LS, Sinha RK, Le Frock JL. Long-term suppression of infection in total joint ­arthroplasty. Clin Orthop Relat Res. 2003;414:55–60.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Disease, Cleveland Clinic Foundation, 9500 Euclid Avenue Desk G-21, Cleveland, OH, 44195, USA

    Steven K. Schmitt M.D.

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  1. Steven K. Schmitt M.D.
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Correspondence to Steven K. Schmitt M.D. .

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Editors and Affiliations

  1. Department of Rheumatologic, and Immunologic Disease, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Brian F. Mandell

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Schmitt, S.K. (2013). Diagnosis and Management of Prosthetic Joint Infection. In: Mandell, B. (eds) Perioperative Management of Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2203-7_22

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  • DOI: https://doi.org/10.1007/978-1-4614-2203-7_22

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