Prevfention and principles of treatment prosthetic joint infections
Abstract
Background: The infections of joint endoprostheses are relatively rare but they represent a major complication after the insertion of the artificial joint. For this reason it is very important to take measures in order to prevent these infections. The measures consist of the following procedures: the preparation of the patient for the operation, the perioperative antibiotic protection and the postoperative prevention of possible later hematogenically occurring infections. The aims of the treatment of prosthetic infections are to stop or alleviate the inflammation, to prevent or reduce the chance of reoccurrence and to prevent a permanent, chronic infection. Clinically we try to achieve a functionally good result. The treatment is normally a combination of a surgical and a long-term antibiotic treatment. The patients with a stable implant, short-lived endoprosthetic infection with a microorganism susceptible to an antimicrobial agent can be successfully treated with debridement and specific antibiotics. In all other patients with a long-lived endoprosthetic infection and loose implant a more invasive procedure such as one-stage or even two-stage exchange has to be chosen.
Conclusions: The treatment of orthopaedic implants is demanding and complicated. Therefore we think that such patients can get proper medical care only in specialized medical centres. When the right treatment procedure has been chosen the prospects of a successful treatment outcome are favourable.
Downloads
References
Schafroth M, Zimmerli W, Brunazzi M, Ochsner PE. Infections. In: Ochsner PE, ed. Total hip replacement. Implantation technique and local complications. Berlin: Springer-Verlag; 2003. p. 65–90.
Trampuž A, Pavlovčič V, Nemec B. Okužbe v ortopediji. ljubljana: Ortopedska klinika; 2001.
Widmer AF. New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 2001; 33 Suppl 2: 94–106.
Murdoch DR, Roberts SA, Fowler Jr VG, Shah MA, Taylor SL. Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Infect Dis 2001; 32: 647–9.
Zimmerli W, Trampuž A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351: 1645–54.
Lotrič-Furlan S, Meglič-Volkar J. Diagnostika, zdravljenje in preprečevanje okužb umetnih sklepov. Med Razgl 2002; 41 Suppl 2: 85–94.
Lentino JR. Infections associated with prosthetic knee and prosthetic hip. Curr Infect Dis Rep 2004; 6: 388–92.
Levine BR, Evans BG. Use of blood culture vial specimens in intraoperative detection of infection. Clin Orthop 2001; 382: 222– 31.
Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg (Br) 2006; 88-B: 149–55.
Corstens FHM, Meer JWM. Nuclear medicine’s role in infection and inflammation. Lancet 1999; 354: 765–70.
Trampuž A, Steckelberg JM, Osmon DR, Cocherill FR, Hanssen AD, Patel R. Advances in the laboratory diagnosis of prosthetic joint infections. Rev Med Microbiol 2003; 14: 1–14.
Atkins BL, Athanason N, Deeks JJ, Crook DW, Simpson H, Peto TE, et al. Prospective evaluation of criteria for microbiologic diagnosis of prosthetic-joint infection at revision arthroplasty. J Clin Microbiol 1998; 36: 2932–9.
Lentino JR. Prosthetic joint infections: Bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis 2003; 36: 1157–61.
Zimmerli W, Ochsner PE. Management of infection associated with prosthetic joints. Infection 2003; 31: 99–108.
Tattevin P, Cremieux AC, Pottier P, Huten D, Carbon C. Prosthetic joint infection: When can salvage be considered? Clin Infect Dis 1999; 29: 292–5.
Fisman ND, Reilly DT, Karchmer AW, Goldie SJ. Clinical effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis 2001; 32: 419–30.
Komisija za antibiotike v KC, Čižman M, Beović B, Marolt-Gomišček M, eds. Navodila za antibiotično zdravljenje v KC 2006.
Widmer AF, Frei R, Rajacic Z, Zimmerli W. Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis 1990; 162: 96–102.
Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopaedic implant-related staphylococcal infections: a randomized controlled trial: foreign-body infection (FBI) study group. JAMA 1998; 279: 1537–41.
Berdal JE, Skramm I, Mowinckel P, Gulbrandsen P, Bjornholt JV. Use of rifampicin and ciprofloxacin combination therapy after surgical debridement in the treatment of early manifestation prosthetic joint infections. Clin Microbiol Infect 2005; 11: 834–55.
Trebše R, Pisot V, Trampuz A. Treatment of infected retained implants. J Bone Joint Surg (Br) 2005; 87-B: 249–56.
Meehan AM, Osmon DR, Duffy CT, Hanssen AD, Keating MR. Outcome of penicillin-susceptible streptococcal prosthetic joint infection treated with debridement and retention of the prosthesis. Clin Infect Dis 2003; 36: 845–9.
Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 2006; 42: 471–8.
Segreti J, Nelson JA, Trenholme GM. Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 1998; 27: 711–3.
Bratzler DW, Houck PM. Antimicrobial prophylaxis of surgery: An advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38: 1706–15
Aasen AO, Barie P, Faist E, Ford HR, Fry DE, Hau T. Current issues in the prevention and management of surgical site infection. Surgical Infections 2002; 3 Suppl 1: S1–S8.
Ainscow DA, Denham RA. The risk of hematogenous infection in total joint replacement. J Bone Joint Surg 1984; 66: 580–2.
Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001; 32: 331–51.
Seymour RA, Whitworth JM, Martin M. Antibiotic prophylaxis for patients with joint prostheses-still a dillema for dental practitioners. Br Dent J 2003; 194: 649–53.
Schoifet SD, Morrey BF. Treatment of infection after total knee arthroplasty by debridement with retention of the components. J Bone Joint Surg (Am) 1990; 72-A: 1383–90.
Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 1997; 24: 914–19.
Deirmengian C, Greenbaum J, Lotke PA, Booth RE Jr, Lonner JH. Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. J Arthroplasty 2003; 18: 22–6.
Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: A common cause of persistent infections. Science 1999; 284: 1318–22.
Frippiat F, Meunier F, Derue G. Place of newer quinolones and rifampicin in the treatment of Gram-positive bone and joint infections. J Anticrob Chemother 2004; 54: 1158.
Trampuž A, Zimmerli W. New strategies for the treatment of infections associated with prosthetic joints. Curr Opin Investig Drugs 2005; 6: 185–90.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
