II. Risk Factors
- Obesity (highest risk)
- Cardiac disease
- Immunocompromised
- Peripheral Vascular Disease
- Inflammatory Arthritis
- Prior joint infection
- Renal disease
- Liver disease
- Malnutrition
- Alcohol Abuse
- Tobacco Abuse
- Diabetes Mellitus
- Anemia
- Tubb (2020) J Am Acad Orthop Surg 28(8): e340-8 [PubMed]
III. Epidemiology
- Prosthetic Joint Infection carries a 1-2% risk at 2 years and >2% at 10 years
- Nearly half of infections occur in the first 3 months after surgery (nearly 80% occur within first 2 years)
- Prosthetic Hip Joint and Prosthetic Knee Joint infections are responsible for most Prosthetic Septic Joints
IV. Causes
- Early infection
- Staphylococcus epidermidis
- Late Infection
- Gram Positive Cocci (e.g. pneumococcus)
- Anaerobic Bacteria
- Pseudomonas
V. Findings
- See Septic Joint
- Findings are more subtle in infected prosthetic joints than in native joint infections
VI. Diagnosis
- Major Criteria
- Two joint cultures positive for same organism
- Sinus tract communicating with joint
- Minor Criteria
- Intraoperative Criteria (optional)
- Score 3: Histology positive
- Score 3: Purulence
- Score 2: Single Culture Positive
- Interpretation
- Infection
- Either major criteria positive OR
- Minor Criteria Score >6 OR
- Minor AND Intraoperative Criteria >6 (with Minor Score at least 2)
- Inconclusive
- Neither major criteria present AND
- Minor AND Intraoperative Criteria 2 to 5 (with Minor Score at least 2)
- No Infection
- Neither major criteria present AND
- Minor Criteria 0 to 1 (or combined with intraoperative criteria <3)
- Infection
- References
VII. Labs
- See Septic Joint
- Synovasure Lateral Flow Test
- Detects human alpha defensins released by activated Neutrophils
- Positive test suggestive of Bacterial periprosthetic infection
VIII. Imaging
- Nuclear scan
- Negative Nuclear scan excludes septic prosthetic joint
- Pet Scan
- Avoid CT Scan or MRI in infected prosthetic joint
- Does not distinguish infected prosthetic joint from other causes of pain
IX. Management
- See Septic Joint
- Empiric therapy before culture results
- Option 1 (2 drug regimen)
- Drug 1: Vancomycin
- Drug 2: Ciprofloxacin, Aztreonam, or Gentamycin
- Option 2 (2 drug regimen)
- Drug 1
- Ciprofloxacin 750 PO bid or
- Ofloxacin 200 mg PO tid
- Drug 2: Rifampin 900 mg PO qd
- Drug 1
- Option 1 (2 drug regimen)
-
Ciprofloxacin and Rifampin sensitive by culture
- Option 1 (2 drug regimen)
- Drug 1: Ciprofloxacin or Ofloxacin
- Drug 2: Rifampin 900 mg PO qd
- Option 2 (2 drug regimen)
- Option 1 (2 drug regimen)
-
Ciprofloxacin or Rifampin resistance by culture
- Vancomycin and
- Rifampin (if sensitive)
X. References
- Buddendorff (2021) Crit Dec Emerg Med 35(12): 18-9
- Earwood (2021) Am Fam Physician 104(6): 589-97 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 213121005 |
| English | infection due to internal joint prosthesis, infection due to internal joint prosthesis (diagnosis), infection due to an internal joint prosthesis, prosthetic joint infection, infections joint prosthetic, infections joints prosthetic, Infected arthroplasty, Infected joint prosthesis, Prosthetic joint infection, Prosthetic joint infection (disorder) |
| Spanish | infección de articulación protésica (trastorno), infección de articulación protésica, infección de prótesis articular, infección de prótesis articular (trastorno), artroplastia infectada |
