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Prosthetic Septic Arthritis: Etiology, Clinical Aspects, and Management

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Infections and the Rheumatic Diseases

Abstract

Periprosthetic joint infection (PJI) is a relatively rare but potentially devastating consequence of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patient risk factors include uncontrolled diabetes, morbid obesity, rheumatoid arthritis, cirrhosis, hepatitis C, immunosuppressive medications, smoking, human immunodeficiency virus infection, and alcohol abuse. Perioperative risk factors include use of perioperative antibiotics, surgical site preparation, surgical attire, and operating room conditions. PJI diagnosis should be based on clinical judgement and incorporate information from the patient’s history and physical exam, serological testing, synovial fluid analysis, radiographic assessment, and microbiologic and histopathologic testing. There are four main types of PJI: early postoperative, late chronic, acute hematogenous, and positive intraoperative cultures at the time of revision for presumed aseptic loosening. Treatment depends on the type of infection, with debridement, antibiotics, and implant retention generally recommended for early postoperative and acute hematogenous infections; single- or two-stage revisions for chronic infections; and antimicrobial therapy without revision for unexpectedly positive cultures.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Anna Cohen-Rosenblum, Scott A. Barnett, Ryan Dewitz, Peter C. Krause & Vinod Dasa

  2. Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Scott J. Melton

  3. Clinical Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Julio E. Figueroa II

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  1. Anna Cohen-Rosenblum
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  2. Scott A. Barnett
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  7. Vinod Dasa
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Correspondence to Vinod Dasa .

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  1. LSU Health Sciences at New Orleans, Louisiana State University, New Orleans, LA, USA

    Luis R. Espinoza

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Cohen-Rosenblum, A. et al. (2019). Prosthetic Septic Arthritis: Etiology, Clinical Aspects, and Management. In: Espinoza, L. (eds) Infections and the Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-23311-2_7

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