Document Type

Article

Publication Date

2011

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Seminars in Arthroplasty Volume 22, Issue 2, June 2011, Pages 100-102. The published version is available at http://www.semarthroplasty.com/article/S1045-4527%2811%2900046-0/abstract. Copyright © Elsevier, Inc.

Abstract

The management of periprosthetic joint infection following total joint arthroplasty is presently a major challenge to orthopedic surgeons. Despite various treatment options available, the two-stage revision procedure is most often chosen in North America because of a high success rate, especially in cases involving resistant organisms. Sometimes the use of antibiotics alone, irrigation with debridement, or a one-stage exchange may be a more appropriate treatment option. Various factors such as the status of a patient’s immune system, time of onset of the infection, as well as susceptibility of causative microorganism should be considered as they play an important role in effectiveness of treatment. When surgery presents a great risk to patients due to their level of health, and infection is caused by a low-virulent antimicrobial susceptible pathogen, antibiotic suppression alone may be the best treatment option. If the patient can successfully undergo surgery then an irrigation and debridement procedure may be preferred, especially with an acute onset of symptoms. If onset of symptoms is much later as in chronic cases, or irrigation and debridement procedure is unsuccessful, then resection of all components and reimplantation is necessary. In a two-stage revision, placement of an antibiotic-loaded spacer is needed to eradicate the infection before reimplantation takes place. There are rare cases in which salvage procedures, such as arthrodesis or amputation, are necessary to completely eradicate an uncontrollable infection in immunocompromised patients.