Rheumatology Book

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Periprosthetic Joint Infection

Aka: Periprosthetic Joint Infection, Prosthetic Joint Infection, Prosthetic Septic Joint, Prosthetic Joint Infection, Infected Joint Replacement
  1. See Also
    1. Septic Joint
    2. Septic Joint Causes
  2. Risk Factors
    1. Obesity (highest risk)
    2. Cardiac disease
    3. Immunocompromised
    4. Peripheral Vascular Disease
    5. Inflammatory Arthritis
    6. Prior joint infection
    7. Renal disease
    8. Liver disease
    9. Malnutrition
    10. Alcohol Abuse
    11. Tobacco Abuse
    12. Diabetes Mellitus
    13. Anemia
    14. Tubb (2020) J Am Acad Orthop Surg 28(8): e340-8 [PubMed]
  3. Epidemiology
    1. Prosthetic Joint Infection carries a 1-2% risk at 2 years and >2% at 10 years
    2. Nearly half of infections occur in the first 3 months after surgery (nearly 80% occur within first 2 years)
    3. Prosthetic Hip Joint and Prosthetic Knee Joint infections are responsible for most Prosthetic Septic Joints
  4. Causes
    1. Early infection
      1. Staphylococcus epidermidis
    2. Late Infection
      1. Gram Positive Cocci (e.g. pneumococcus)
      2. Anaerobic Bacteria
      3. Pseudomonas
  5. Findings
    1. See Septic Joint
    2. Findings are more subtle in infected prosthetic joints than in native joint infections
  6. Diagnosis
    1. Major Criteria
      1. Two joint cultures positive for same organism
      2. Sinus tract communicating with joint
    2. Minor Criteria
      1. Score 2: Serum C-RP > 10 mg/L or D-Dimer > 860 ng/ml
      2. Score 1: Serum ESR >30 mm/hour
      3. Score 3: Synovial WBC >3000/uL or Leukocyte esterase (2+)
      4. Score 3: Synovial Alpha-defensin (signal to cutoff ratio >1)
      5. Score 2: Synovial PMNs >80%
      6. Score 1: Synovial C-RP >6.9 mg/L
    3. Intraoperative Criteria (optional)
      1. Score 3: Histology positive
      2. Score 3: Purulence
      3. Score 2: Single Culture Positive
    4. Interpretation
      1. Infection
        1. Either major criteria positive OR
        2. Minor Criteria Score >6 OR
        3. Minor AND Intraoperative Criteria >6 (with Minor Score at least 2)
      2. Inconclusive
        1. Neither major criteria present AND
        2. Minor AND Intraoperative Criteria 2 to 5 (with Minor Score at least 2)
      3. No Infection
        1. Neither major criteria present AND
        2. Minor Criteria 0 to 1 (or combined with intraoperative criteria <3)
    5. References
      1. Parvizi (2018) J Arthroplasty 33(5): 1309-14 [PubMed]
  7. Labs
    1. See Septic Joint
    2. Synovasure Lateral Flow Test
      1. Detects human alpha defensins released by activated Neutrophils
      2. Positive test suggestive of Bacterial periprosthetic infection
  8. Imaging
    1. Nuclear scan
      1. Negative Nuclear scan excludes septic prosthetic joint
    2. Pet Scan
    3. Avoid CT Scan or MRI in infected prosthetic joint
      1. Does not distinguish infected prosthetic joint from other causes of pain
  9. Management
    1. See Septic Joint
    2. Empiric therapy before culture results
      1. Option 1 (2 drug regimen)
        1. Drug 1: Vancomycin
        2. Drug 2: Ciprofloxacin, Aztreonam, or Gentamycin
      2. Option 2 (2 drug regimen)
        1. Drug 1
          1. Ciprofloxacin 750 PO bid or
          2. Ofloxacin 200 mg PO tid
        2. Drug 2: Rifampin 900 mg PO qd
    3. Ciprofloxacin and Rifampin sensitive by culture
      1. Option 1 (2 drug regimen)
        1. Drug 1: Ciprofloxacin or Ofloxacin
        2. Drug 2: Rifampin 900 mg PO qd
      2. Option 2 (2 drug regimen)
        1. Drug 1: Oxacillin 2 grams IV every 4 hours
        2. Drug 2: Rifampin 900 mg PO qd
    4. Ciprofloxacin or Rifampin resistance by culture
      1. Vancomycin and
      2. Rifampin (if sensitive)
  10. References
    1. Buddendorff (2021) Crit Dec Emerg Med 35(12): 18-9
    2. Earwood (2021) Am Fam Physician 104(6): 589-97 [PubMed]

Prosthetic joint infection (C0410808)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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