Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?

Abstract Prosthetic joint infection (PJI) of the hip and knee remains one of the most common and feared arthroplasty complications. The impact and cost of PJI is significant, both to the patient and to the health care system. Recent reports of results of different treatment strategies have led many...

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Bibliographic Details
Published in:The Journal of arthroplasty 2015-06, Vol.30 (6), p.912-918
Main Authors: Jiranek, William A., MD, Waligora, Andrew C., MD, Hess, Shane R., DO, Golladay, Gregory L., MD
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
antibiotic spacers
Arthroplasty, Replacement, Hip - adverse effects
Arthroplasty, Replacement, Knee - adverse effects
Debridement
Humans
irrigation and debridement
Orthopedics
periprosthetic infection
Prosthesis-Related Infections - etiology
Prosthesis-Related Infections - surgery
Reoperation - methods
revision hip arthroplasty
revision knee arthroplasty
Risk Assessment
Therapeutic Irrigation
Treatment Failure
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Summary:Abstract Prosthetic joint infection (PJI) of the hip and knee remains one of the most common and feared arthroplasty complications. The impact and cost of PJI is significant, both to the patient and to the health care system. Recent reports of results of different treatment strategies have led many surgeons to modify their approach to management of PJI. This paper will explore apparent paradigm shifts, both to indications and technique, including the importance of waiting for bacterial identification, the decreasing role for irrigation and debridement (I&D) with retention of components, the increased utilization of single stage revision, and conversely a decreasing role for two-stage exchange. Strategies for treating drug-resistant organisms and management of failed treatment will also be examined.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2015.03.014