Key Points
ÎÎProsthetic joint infection (PJI) remains one of the most serious
complications of prosthetic joint implantation.
ÎÎThe 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.
ÎÎThe management of PJI almost always necessitates the need for
surgical intervention and prolonged courses of intravenous or oral
antimicrobial therapy.
ÎÎAn 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
ÎÎThe presence of a sinus tract that communicates with the prosthesis is
definitive evidence of PJI (B-III).
ÎÎThe presence of purulence surrounding the prosthesis without another
known etiology is definitive evidence of PJI (B-III).
ÎÎThe 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).
ÎÎTwo 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.
ÎÎThe 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.
