Management of Periprosthetic Hip Joint Infection

Abstract

Total hip joint replacement offers dramatic improvement in the quality of life but periprosthetic joint infection (PJI) is the most devastating complication of this procedure. The infection threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient due to long term hospitalization and high cost. For the surgeon it is a disastrous burden, which requires repeated, complicated procedures to eradicate infection and to provide a mobile joint without pain. Yet in the absence of a true gold standard, the diagnosis of PJI can be elusive. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of PJI. Treatment options mainly include thorough irrigation and debridement with prosthesis retention, or a two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic PJI. Debridement, antibiotics and implant retention is the obvious choice for treatment of acute PJI, with good success rates in selected patients. This article presents an overview of recent management concepts for PJI of the hip emphasizing diagnosis and the clinical approach, and also share own experience at our institution.

Case for diagnosis. Suppurative nodule or something deeper?

“…Treatment in two stages using a spacer is recommended for most chronic PJI. 5 In the current case, resolution of the lesion occurred after prosthesis revision surgery and subsequent focus control.…”

State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty

“…Likewise, very few studies have assessed the choice of antibiotics when the cultures are not yet known; vancomycin appears to be an alternative, although a categorical recommendation cannot be made. 72 …”

Extracellular Vesicle Isolation and Characterization from Periprosthetic Joint Synovial Fluid in Revision Total Joint Arthroplasty

“…The periprosthetic joint infection (PJI) is a frequent and devastating complication following knee or hip arthroplasty with dramatic impact on patients and healthcare systems [1][2][3]. The prospectively important distinction between PJI and aseptic implant failure (AIF) remains challenging and often requires an ensemble of various diagnostic tests due to the lack of a gold standard [3][4][5]. Consequently, much effort has been made to explore new PJI biomarkers over the last years [6,7].…”