Prosthetic joint infection guidelines released

Dec 7 2012

By Lynda Williams, Senior medwireNews Reporter

The Infectious Diseases Society of American has released guidelines for the diagnosis and care of patients with a prosthetic joint infection (PJI).

"The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient," explained lead author Douglas Osomon (Mayo Clinic, Rochester, Minnesota, USA) in a press release.

By strong collaboration between specialists such as orthopedic and plastic surgeons, internists, and infectious disease clinicians, the authors believe that consideration of the guidelines may "help reduce morbidity, mortality, and the costs associated with PJI."

The report, published in Clinical Infectious Diseases, recommends physicians consider PJI for patients with persistent wound drainage or a sinus tract over the replaced joint, sudden onset of pain after pain-free years, or ongoing pain after implantation, especially where infection or healing wounds has previously been an issue.

Patients should be managed with an orthopedic referral for physical examination, blood cultures, measurement of C-reactive protein and sedimentation rate, and a plain radiograph of the prosthesis, the team states. Where infection is indicated, patients should undergo arthrocentesis, preferably after withdrawal of antimicrobial therapy for 2 weeks, and synovial fluid should be checked for cells present, and both aerobic and anaerobic organisms.

While blood cultures should be taken for patients with fever or bacterial infections at other sites, there is no need for imaging such as magnetic resonance imaging or bone scans.

For patients with PJI, treatment is dependent on the length of time since prosthesis implantation and whether the prosthesis is well fixed and has a sinus tract, explain the authors.

Debridement should be considered for patients with infection within 30 days of implantation or symptoms lasting less than 3 weeks, whereas prosthesis removal may be more appropriate for other patients due to risk for further infection. A replacement prosthesis may be implanted at the same time or at a later date depending on risk factors.

For patients who are not ambulatory, have resistant infections, or other complications, permanent resection arthoplasty may be required. Amputation should be the "last option considered," and specialists should be consulted before nonemergency surgery, the researchers emphasize.

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