Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?
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.
Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia.
William A
WA
Jiranek
Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia.
Andrew C
AC
Waligora
Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia.
Shane R
SR
Hess
Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia.
Gregory L
GL
Golladay
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003646:Debridement; D006801:Humans; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D007507:Therapeutic Irrigation; D017211:Treatment Failure
D000900:Anti-Bacterial Agents
antibiotic spacers; irrigation and debridement; periprosthetic infection; revision hip arthroplasty; revision knee arthroplasty