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Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts.
World J Orthop 2014; 5(5):667-76WJ

Abstract

Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients.

Authors+Show Affiliations

Jesse WP Kuiper, Center for Orthopaedic Research Alkmaar, Medical Center Alkmaar, 1815 JD, Alkmaar, The Netherlands.Jesse WP Kuiper, Center for Orthopaedic Research Alkmaar, Medical Center Alkmaar, 1815 JD, Alkmaar, The Netherlands.Jesse WP Kuiper, Center for Orthopaedic Research Alkmaar, Medical Center Alkmaar, 1815 JD, Alkmaar, The Netherlands.Jesse WP Kuiper, Center for Orthopaedic Research Alkmaar, Medical Center Alkmaar, 1815 JD, Alkmaar, The Netherlands.Jesse WP Kuiper, Center for Orthopaedic Research Alkmaar, Medical Center Alkmaar, 1815 JD, Alkmaar, The Netherlands.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25405096

Citation

Kuiper, Jesse Wp, et al. "Treatment of Acute Periprosthetic Infections With Prosthesis Retention: Review of Current Concepts." World Journal of Orthopedics, vol. 5, no. 5, 2014, pp. 667-76.
Kuiper JW, Willink RT, Moojen DJ, et al. Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. World J Orthop. 2014;5(5):667-76.
Kuiper, J. W., Willink, R. T., Moojen, D. J., van den Bekerom, M. P., & Colen, S. (2014). Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. World Journal of Orthopedics, 5(5), pp. 667-76. doi:10.5312/wjo.v5.i5.667.
Kuiper JW, et al. Treatment of Acute Periprosthetic Infections With Prosthesis Retention: Review of Current Concepts. World J Orthop. 2014 Nov 18;5(5):667-76. PubMed PMID: 25405096.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. AU - Kuiper,Jesse Wp, AU - Willink,Robin Tjeenk, AU - Moojen,Dirk Jan F, AU - van den Bekerom,Michel Pj, AU - Colen,Sascha, Y1 - 2014/11/18/ PY - 2014/01/06/received PY - 2014/04/28/revised PY - 2014/05/31/accepted PY - 2014/11/19/entrez PY - 2014/11/19/pubmed PY - 2014/11/19/medline KW - Acute KW - Arthroplasty KW - Debridement KW - Debridement antibiotics and implant retention KW - Infection KW - Periprosthetic joint infection KW - Prosthesis KW - Retention SP - 667 EP - 76 JF - World journal of orthopedics JO - World J Orthop VL - 5 IS - 5 N2 - Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients. SN - 2218-5836 UR - https://www.unboundmedicine.com/medline/citation/25405096/Treatment_of_acute_periprosthetic_infections_with_prosthesis_retention:_Review_of_current_concepts_ L2 - http://www.wjgnet.com/2218-5836/full/v5/i5/667.htm DB - PRIME DP - Unbound Medicine ER -