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Chapter 9 : Prosthetic Joint Infections

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Abstract:

Prosthetic joint implantation is among the most remarkable advances in surgery and medicine to occur during the last three decades. Five hundred seventy-eight cases of total hip and total knee prosthetic arthroplasty infections seen at the Mayo Clinic between 1992 and 1997 were classified as definite infections according to a strict case definition. The clinical presentation of prosthetic joint infection is highly variable, ranging from the syndrome of acute septic arthritis with the sudden onset of joint pain, erythema, swelling, fever, and systemic symptoms to a syndrome of indolent loosening and chronic pain, which is difficult to distinguish from aseptic loosening on the basis of symptoms and clinical examination alone. This chapter discusses the utility of various diagnostic tests used to diagnose prosthetic joint infection. For patients undergoing revision total joint arthroplasty, pathological examination of intraoperative frozen sections is useful in selected cases to detect infection. Antimicrobial therapy without concomitant surgical intervention is not considered standard therapy for prosthetic joint infection. The oral antibiotic used for chronic suppression should be chosen based on susceptibility test results, long-term tolerability, and cost. Antimicrobial prophylaxis has been utilized traditionally in operative procedures that have a high rate of postoperative wound infection, when foreign materials must be implanted, or in operative procedures in which the wound infection rate is low but the development of a wound infection would result in a catastrophic event.

Citation: Steckelberg J, Osmon D. 2000. Prosthetic Joint Infections, p 173-209. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch9

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Figure 1

Infected total hip arthroplasty with four draining sinus tracts.

Citation: Steckelberg J, Osmon D. 2000. Prosthetic Joint Infections, p 173-209. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch9
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Image of Figure 2
Figure 2

Plain radiograph of an infected TKA illustrating lucency at the bone-cement interface of both the femoral and tibial components.

Citation: Steckelberg J, Osmon D. 2000. Prosthetic Joint Infections, p 173-209. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch9
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Image of Figure 3
Figure 3

Technetium-99 bone scan and indium-labelled leukocyte scan demonstrating uptake around both components of the infected TKA shown in Fig. 2 .

Citation: Steckelberg J, Osmon D. 2000. Prosthetic Joint Infections, p 173-209. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch9
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