New Developments in Diagnosis and Treatment of Infection in Orthopedic Implants

Abstract

Orthopedic implants have revolutionized treatment of bone fractures and noninfectious joint arthritis. Today, the risk for orthopedic device-related infection (ODRI) is <1%-2%. However, the absolute number of patients with infection continuously increases as the number of patients requiring such implants grows. Treatment of ODRIs most frequently includes long-term antimicrobial treatment and removal of the implant. Recent evidence from observational trials and 1 randomized clinical trial indicate that a subset of patients can be successfully treated with retention of the implant. Patients eligible for such a treatment must meet the following criteria: acute infection defined as signs and symptoms lasting <14-28 days, an unambiguous diagnosis based on histopathology and microbiology, a stable implant, and susceptibility of the microorganism to an effective orally available antimicrobial agent.

Patients with Prosthetic Joint Infection on IV Antibiotics are at High Risk for Readmission

“…PJI are one of the most common complications of joint arthroplasty, along with aseptic loosening [14] and dislocation of prosthetic components [6,12]. Rates of PJI in most centers currently range between 0.5% to 1% for hip arthroplasties [2,13], 0.5% to 2% for knee arthroplasties [2,13], and less than 1% for shoulder arthroplasties [9]. PJI cause significant morbidity and account for a substantial proportion of health care expenditures [4,10].…”

Sonication cultures of explanted components as an add‐on test to routinely conducted microbiological diagnostics improve pathogen detection

“…1 Patients are confronted with prolonged hospitalization; additional surgery associated with higher risk of complications and longtime antimicrobial treatment, as well as the possibility of renewed and/or permanent disability. 2 Although much effort has already been expended on reducing the incidence of prosthetic infections, 1,3,4 the incidence of joint infection after primary joint arthroplasty is about 1% for hip and shoulder prostheses, about 2% for knee prostheses, and up to 9% in elbow prostheses. 5,6 Additionally, these infections are associated with considerable costs.…”

The role of small-colony variants in failure to diagnose and treat biofilm infections in orthopedics

“…Bacteria in a biofilm are able to resist higher antibiotic concentrations than planktonic bacteria. In general, bacteria in a biofilm are 10-1,000 times more resistant to antibiotics than their planktonic counterparts (Widmer 2001, Mah et al 2003. Also, some bacteria (such as Staphylococcus aureus) form small-colony variants, characterized by reduced growth rate, resistance to aminoglycosides, and possible intracellular persistence .…”