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Prosthetic Joint Infection

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Key Points ����Prosthetic joint infection (PJI) remains one of the most serious complications of prosthetic joint implantation. ����The cumulative incidence of prosthetic joint infection among the approximately 1,000,000 primary total hip (THA) and knee (TKA) arthroplasties performed in the United States of America in 2009 varies between ~1-2% over the lifetime of the prosthetic joint, depending on the type of prosthesis and whether the surgery is a primary or revision procedure. ����The management of PJI almost always necessitates the need for surgical intervention and prolonged courses of intravenous or oral antimicrobial therapy. ����An essential component of the care of patients with PJI is strong collaboration between all involved medical and surgical specialists (eg, orthopedic surgeons, plastic surgeons, infectious disease specialists, internists, etc.). Diagnosis and Assessment Definition of PJI ����The presence of a sinus tract that communicates with the prosthesis is definitive evidence of PJI (B-III). ����The presence of purulence surrounding the prosthesis without another known etiology is definitive evidence of PJI (B-III). ����The presence of acute inflammation as defined by the attending pathologist on histopathologic examination of periprosthetic tissue at the time of surgical debridement or prosthesis removal is highly suggestive evidence of PJI (B-II). ����Two or more intraoperative cultures or a combination of preoperative aspiration and intraoperative cultures that yield the same organism (indistinguishable based on common laboratory tests including genus and species identification or common antibiogram) may be considered definitive evidence of PJI (B-III). ������ Growth of a virulent microorganism (eg, S. aureus) in a single specimen of a tissue biopsy or synovial fluid may also represent PJI. ������ One of multiple tissue cultures or a single aspiration culture that yields an organism that is a common contaminant (eg, coagulase-negative staphylococci, Propionibacterium acnes) should not necessarily be considered evidence of definite PJI and should be evaluated in the context of other available evidence. ����The presence of PJI is possible even if the above criteria are not met. (B-III). The clinician should use his/her clinical judgment to determine if this is the case after reviewing all the available preoperative and intraoperative information.

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