Consensus document on controversial issues in the diagnosis and treatment of prosthetic joint infections

Abstract

A systematic literature search using the MEDLINE database for the period 1988 to 2008 of randomized controlled trials and/or non-randomized studies was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence and strength of recommendation was applied.

Prosthetic Joint Infection

“…More than 25% of the patients in that study also had a draining sinus and had a good result, similar to a previous study that found a high success rate for patients with a draining sinus (386). Nevertheless, patients with a sinus tract are typically treated with a two-stage arthroplasty exchange (60,352,354).…”

“…This is supported by the finding that the risk of failure increases 4-fold after antimicrobials are stopped, with most failures occurring in the first 4 months after antimicrobials are stopped (349). Conversely, others suggest that therapy can be stopped in an asymptomatic patient with a normal CRP result and negative nuclear medicine imaging results (352). Due to falsepositive nuclear medicine imaging results that may occur up to several years after revision, this is not common practice and is of uncertain value.…”

“…Selection of patients for a DAIR procedure. Patients in whom the DAIR procedure is to be used should have a short duration of symptoms, a stable implant, and no sinus tract (60,(352)(353)(354). Ideally, the infecting pathogen should be susceptible to multiple antimicrobials (353), but this may not be known when this surgical strategy is selected.…”

“…While reported in a small number of cases in the literature on knee arthroplasty infection (387), a one-stage arthroplasty exchange is typically used only for patients with hip arthroplasty infection. Patients for whom a one-stage arthroplasty exchange is appropriate have adequate remaining bone stock, an identified pathogen that is susceptible to antimicrobials available orally and in PMMA, and surrounding soft tissue in good condition (60,352). While most patients who require bone grafting are treated with a twostage arthroplasty exchange, one small study reported a good outcome for those patients who were managed with one-stage arthroplasty exchange (388).…”

The Microbiological Profiles of Infected Prosthetic Implants with an Emphasis on the Organisms which Form Biofilms

“…The frequency of the aetiological agents varies among the published reports [10,11]. In the present study, aerobic gram positives cocci accounted for 60.9% (39) cases and aerobic gram negatives accounted for 37.5% (24) cases.…”