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26 - Prosthetic Joint Infections

from Part I - Systems

Published online by Cambridge University Press:  15 December 2009

James M. Mok
Affiliation:
Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA
Serena S. Hu
Affiliation:
Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
Rachel L. Chin
Affiliation:
University of California, San Francisco
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Summary

INTRODUCTION

Prosthetic joint infection is a feared complication of total joint replacement surgery and occurs as a result of bacterial contamination of the implant surface. It can occur at any point after the initial operation and is characterized by a slow, indolent course that usually results in a delay in diagnosis. Diagnosis and treatment are difficult, and eradication by nonoperative means is rare if not impossible. The consequences of misdiagnosis are substantial and may lead to unnecessary surgery in the case of a false positive. Delays in diagnosis can make control of the infection more difficult and necessitate removal of the prosthesis, which entails prolonged immobilization and delayed reimplantation.

EPIDEMIOLOGY

Approximately 500,000 primary joint arthroplasties are performed every year in the United States. Infection is relatively rare, occurring in 1–2% of primary surgeries, but represents the second leading cause of failure. Treatment for prosthetic joint infection costs an estimated $250 million annually in the United States. The causative organisms are usually Staphylococcus aureus or Staphylococcus epidermidis.

CLINICAL FEATURES

Pain is the most common presenting symptom (Table 26.1). Drainage is the second most common and is strongly suggestive of infection if it is present several weeks postoperatively. Fever is rarely present. The presentation is often subacute, and complaints of pain must be approached with a high degree of suspicion for infection. Most prosthetic joint infections occur as late infections.

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Bauer, T W, Parvizi, J, Kobayashi, N, Krebs, V.Diagnosis of periprosthetic infection. J Bone Joint Surg Am 2006 Apr;88(4):869–82.Google Scholar
Valle, Della C J, Zuckerman, J D, Cesare, Di P E. Periprosthetic sepsis. Clin Orthop 2004 Mar;(420):26–31.CrossRefGoogle Scholar
Hanssen, A D, Spangehl, M J. Treatment of the infected hip replacement. Clin Orthop 2004 Mar;(420):63–71.CrossRefGoogle Scholar
Larsson, S, Thelander, U, Friberg, S.C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop 1992 Feb;(275):237–42.Google Scholar
Zimmerli, W, Trampuz, A, Ochsner, P E. Prosthetic-joint infections. N Engl J Med 2004 Oct 14;351(16):1645–54.CrossRefGoogle Scholar

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  • Prosthetic Joint Infections
    • By James M. Mok, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.027
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  • Prosthetic Joint Infections
    • By James M. Mok, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.027
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Prosthetic Joint Infections
    • By James M. Mok, Department of Orthopaedic Surgery, University of California, San Francisco School of Medicine, San Francisco General Hospital, San Francisco, CA, Serena S. Hu, Professor of Orthopaedic Surgery, Co-Director, UCSF Spine Care Center, University of California, San Francisco School of Medicine, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.027
Available formats
×