Management of Resistant, Atypical and Culture-negative Periprosthetic Joint Infections after Hip and Knee Arthroplasty

The Open Orthopaedics Journal
Alexander S McLawhornAmar S Ranawat

Abstract

Periprosthetic joint infection (PJI) is a devastating complication following lower extremity total joint arthroplasty (TJA). It is a leading cause of morbidity and revision following TJA. As such, PJI is a significant driver of healthcare costs. The prevalence of PJI related to resistant and atypical organisms is increasing, and approximately 10-30% of PJIs are culture-negative. The purpose of this review is to summarize the current epidemiology, diagnostics, and management of PJI associated with resistant and atypical pathogens and of culture-negative PJIs. The published literature related to the epidemiology, diagnosis, and management of atypical, drug-resistant, and culture-negative PJI is reviewed. The clinical diagnosis of PJI is often challenging, particularly when pathogens are fastidious or when antibiotics have been administered empirically. Molecular diagnostic studies, such as synovial α-defensin, may provide rapid, accurate identification of PJI, even in the setting of concurrent antibiotics administration or systemic inflammatory disease. Once PJI is diagnosed, two-stage exchange arthroplasty remains the gold standard for treating PJI with resistant microorganisms, since there is a high rate of treatment failure wi...Continue Reading

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Citations

Jan 8, 2021·Journal of Medical Microbiology·Tim Holm JakobsenTrine Rolighed Thomsen
Jul 4, 2020·The Journal of Bone and Joint Surgery. American Volume·George A KomnosJavad Parvizi
May 22, 2020·Indian Journal of Medical Microbiology·Rahul GeorgePradeep Mathew Poonnoose
Oct 1, 2019·Indian Journal of Medical Microbiology·Rahul GeorgePradeep Mathew Poonnoose
Mar 13, 2021·Journal of Shoulder and Elbow Surgery·Erik S ContrerasGregory L Cvetanovich
Aug 8, 2021·Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi·Yang-Jing LinGuang-Xing Chen

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Methods Mentioned

BETA
total hip arthroplasty
biopsy
PCR
amputation

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