Firstline - Clinical Decisions

Guidelines

Prosthetic Joint Infection

Diagnosis & Evaluation

Definition

The presence of a sinus tract that communicates with prosthesis
Purulence without other defined etiology
Periprosthetic inflammation on histopathologic exam
Same organism from ≥ 2 cultures
Growth of a virulent organism (S. aureus) in a single specimen

Pre-op Evaluation

ESR and/or CRP
Plain radiograph
Arthrocentesis if appropriate
Blood cultures when bacteremia suspected

Intra-op Evaluation

Histopathological examination if pathologist is available
Send 5-7 deep tissue specimens for culture

Treatment

Debridement and Retention of Prosthesis

Including polyethylene liner exchanges

Resection Arthroplasty with or without Planned Staged Reimplantation

1-stage Exchange or Direct Exchange Strategy

Amputation

More Information

Reference

IDSA Guidelines for Prosthetic Joint Infection. Clinical Infectious Diseases 2013.