Prosthetic joint infection: Guidelines and recommendations update

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Joint replacement surgery is a modern success story with clear clinical and societal benefits; infection of the prosthesis is one of the most feared complications. The behaviour of microorganisms in the setting of prosthetic material and the role of biofilm dictate the approaches to diagnosis and management of these infections. Recognising the impact of patient-related factors, such as diabetes mellitus and obesity, on the development of infections is important.
Diagnosing infection requires application and interpretation of a number of investigations: no investigation has perfect sensitivity or specificity. A high index of suspicion for infection is key, especially in patients with painful joints. Suspicion of infection calls for routine serum inflammatory markers, aspiration of the index joint for assessment of the synovial fluid white cell count and neutrophil percentage, and synovial fluid culture. With revision surgery or arthrotomy for suspected or proven infection, collection of three tissue samples minimum for microbiological culture and histological assessment aids diagnosis. Sonicating the prosthesis and/or applying molecular polymerase chain techniques helps in culture-negative cases, including in patients recently exposed to antimicrobials. Newer tests such as alpha-defensin are promising but need further examination.
Management is contingent on acuity of presentation and organisms isolated. Debridement and implant retention strategies with administration of anti-biofilm agents are a reasonable strategy with acute infection with stable implant. Chronic infections require removal with or without reimplantation of a new prosthesis. Optimal duration of antimicrobial therapy remains under investigation.
Prevention targets optimisation of comorbid disease in patients undergoing joint replacement and minimising wound contamination during and after surgery. Recent WHO and CDC guidelines provide evidence-based recommendations for infection prevention following surgery, including in patients undergoing joint replacement.
Original languageEnglish
Title of host publicationProsthetic Joint Infections
EditorsTrisha Peel
Place of PublicationCham, Switzerland
Number of pages10
ISBN (Electronic)9783319652504
ISBN (Print)9783319652498
Publication statusPublished - 2018

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