Treatment
Figure 2. Management of PJI-II
Duration of symptoms < 3 weeks
OR
Joint age < 30 days
YES
NO
• Well fixed prosthesis
• Absence of sinus tract
• Susceptible to oral
antimicrobial agentsa
YES
Debridement
and retention
a
b
NO
Removal of
prosthesisb
Antimicrobial agents that are safe for prolonged use for chronic suppression or treatment of biofilm
bacteria (see full text guidelines for details)
See Figure 3 and full text guidelines for possible exceptions
Figure 3. Management of PJI-III - Removal of Prosthesis
The patient has:
• THAa
• Good soft tissue
• Good bone stock
• Preoperatively identified
organisms susceptible to
oral agents with high oral
bioavailability
• Available antibioticimpregnated bone cement for
fixation
• No requirment for bone grafting
One-stage
exchange
a
b
8
Uncommonly performed in the US
Relative indications -- See full text guidelines
The patient has:
• Poor soft tissue, OR
• Difficult-to-treat micro-organisms,
AND
• No prior two-stage exchange for
infection OR prior two-stage
exchange and reason for failureb
AND
• Technically feasible delayed
reimplantation, AND
• Anticipated good functional outcome
YES
NO
Two-stage
exchange
See Figure 4
