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Prosthetic Joint Infection - Coggle Diagram
Prosthetic Joint Infection
Epidemiology
Infection of implanted joint
Hip and knee most common
Risk Factors
Underlying systemic disease
Bloodstream infections
Staph. aureus
Wound/surgical site infections
Previous operation on the same joint
Obesity
Malignancy
Advanced age
Malnutrition
Diabetes mellitus
Rheumatoid arthritis
Causative Organisms
Staphylococci (50%)
Coagulase - staphylococci
Staph. aureus
MSSA
MRSA
Other skin flora
Cutibacterium acnes
Corynebacterium
Streptococci
Groups A, B, C, G
Viridans streptococci
Enterococci
Enterobacteriaceae
E. Coli
Klebsiella
Pseudomonas
Anaerobes
Candida
Pathogenesis
Exogenous (early)
Intraoperative contamination of joint
Postoperative wound infection spreading to joint
Present within 12 months of surgery
Haematogenous (later)
≥12 months postop
Metal in body = higher risk of infection
Bacteria forms a biofilm over prosthetic device
Hard to penetrate with antibiotics
Clinical Manifestations
Same as septic arthritis
Fever
Joint pain, swelling, erythema
Reduced mobility
Acute or gradual onset
May also have...
Non-healing wound
Persistant wound discharge
Sinus tract to joint
Diagnosis
Same as with native joint
History
Risk factors
Examination
Examine joint
Examine heart for murmur
Investigations
Microbiology
Blood cultures
Joint samples
Fluid
Tissue
Multiple samples
Gram stain
Culture
Sensitivity testing
Explanted joint
Radiology
X-ray
Radioluscency at metal-bone interface
Bone destruction
Loosening of implant
CT scan
More supportive than diagnostic
Treatment/Prevention
Surgical debridement of joint
Removal of implant
Antibiotics
Targeted against causative organism
4 weeks - 6 months
IV first then oral afterwards
Agents with good bone/biofilm penetration
Coagulase - staphylococci
IV Vancomycin
Staph. aureus
Revision
1 stage revision
Implant retraction
Debridement
New prosthesis
2 stage revision
Implant retraction
Debridement
Add spacer (temporary hardware
Closure
Antibiotics
Return new joint
Defunction joint up to 6 weeks
Prevention
Preoperative
Optimize patient health
MRSA screening/decolonization
Skin disinfection
Intraoperative
Antibiotic prophylaxis
Cutaneous preparation
Operative environment
Blood conservation
Postoperative
Evacuation drains