Assessing risk of prosthetic joint infection

2018 ◽  
pp. 9-12
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
High Risk ◽  
Prosthetic Joint Infection ◽  
Elective Surgery ◽  
Joint Infection ◽  
High Risk Patient ◽  
Prosthetic Joint ◽  
Risk Patients ◽  
Marginal Gain ◽  
Cellular Turnover

This chapter discusses assessing the risk of prosthetic joint infection (PJI) and includes discussion on high-risk patients (classified by age, skin colour, extracellular matrix, cellular turnover, diabetes, obesity, rheumatoid arthritis, previous periarticular fractures and skin disorders). The aim is to allow the practitioner to identify high-risk patient attributes that can be positively influenced such that the risk of PJI is reduced. There are some patients with more than one risk factor and, as such, every effort must be made to reduce each even if there is a marginal gain in each. Delaying elective surgery until the risks of PJI are reduced must be encouraged but must be balanced with alleviating patient symptoms.

scholarly journals Extended Antibiotic Prophylaxis May Be Linked to Lower Peri-prosthetic Joint Infection Rates in High-Risk Patients: An Evidence-Based Review

2019 ◽  
Vol 15 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Christopher J. DeFrancesco ◽  
Michael C. Fu ◽  
Cynthia A. Kahlenberg ◽  
Andy O. Miller ◽  
Mathias P. Bostrom
Keyword(s):  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Evidence Based ◽  
Infection Rates ◽  
High Risk Patients ◽  
Prosthetic Joint ◽  
Risk Patients

scholarly journals Risk of Recurrent Staphylococcus aureus Prosthetic Joint Infection in Rheumatoid Arthritis Patients—A Nationwide Cohort Study

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Namrata Singh ◽  
Rajeshwari Nair ◽  
Michihiko Goto ◽  
Martha L Carvour ◽  
Ryan Carnahan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Prosthetic Joint Infection ◽  
Proportional Hazards ◽  
Joint Infection ◽  
International Classification Of Diseases ◽  
Cox Proportional Hazards ◽  
Prosthetic Joint ◽  
Implant Retention

AbstractBackgroundTreatment of rheumatoid arthritis (RA) often involves immune-suppressive therapies. Concern for recurrent prosthetic joint infection (PJI) in RA patients might be high and could reduce use of joint implantation in these patients. We aimed to evaluate the risk of recurrence of PJI in RA patients compared with osteoarthritis (OA) patients by utilizing a large health care system.MethodsWe conducted a retrospective cohort study of all patients admitted for a Staphylococcus aureus PJI who underwent debridement, antibiotics, and implant retention (DAIR) or 2-stage exchange (2SE) between 2003 and 2010 at 86 Veterans Affairs Medical Centers. Both RA patients and the comparison group of osteoarthritis (OA) patients were identified using International Classification of Diseases, Ninth Revision, codes. All index PJI and recurrent positive cultures for S. aureus during 2 years of follow-up were validated by manual chart review. A Cox proportional hazards regression model was used to compare the time to recurrent PJI for RA vs OA.ResultsIn our final cohort of 374 veterans who had either DAIR or 2SE surgery for their index S. aureus PJI, 11.2% had RA (n = 42). The majority of the cohort was male (97.3%), and 223 (59.6%) had a methicillin-susceptible S. aureus PJI. RA patients had a similar risk of failure compared with OA patients, after adjusting for covariates (hazard ratio, 0.81; 95% confidence interval, 0.48–1.37).ConclusionsPrior diagnosis of RA does not increase the risk of recurrent S. aureus PJI. Further studies are needed to evaluate the effect of different RA therapies on outcomes of episodes of PJI.

scholarly journals Outcome of Prosthetic Joint Infection in Patients with Rheumatoid Arthritis: The Impact of Medical and Surgical Therapy in 200 Episodes

2006 ◽  
Vol 42 (2) ◽  
pp. 216-223 ◽  
Author(s):  
E. F. Berbari ◽  
D. R. Osmon ◽  
M. C. T. Duffy ◽  
R. N. W. Harmssen ◽  
J. N. Mandrekar ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Surgical Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
The Impact

scholarly journals Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis

2008 ◽  
Vol 59 (12) ◽  
pp. 1713-1720 ◽  
Author(s):  
Tim Bongartz ◽  
Christine S. Halligan ◽  
Douglas R. Osmon ◽  
Megan S. Reinalda ◽  
William R. Bamlet ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Knee Replacement ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Total Hip ◽  
Prosthetic Joint

Anti-tumor necrosis factor therapy in rheumatoid arthritis patients with a history of deep prosthetic joint infection: a report of four cases

2011 ◽  
Vol 21 (5) ◽  
pp. 542-547
Author(s):  
Yuji Hirano ◽  
Toshihisa Kojima ◽  
Yasuhide Kanayama ◽  
Tomone Shioura ◽  
Masatoshi Hayashi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Prosthetic Joint Infection ◽  
Tumor Necrosis ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
History Of ◽  
Factor Therapy ◽  
Necrosis Factor

Joint aspiration, including culture of reaspirated saline after a ‘dry tap’, is sensitive and specific for the diagnosis of hip and knee prosthetic joint infection

2018 ◽  
Vol 100-B (6) ◽  
pp. 749-754 ◽  
Author(s):  
D. G. Partridge ◽  
C. Winnard ◽  
R. Townsend ◽  
R. Cooper ◽  
I. Stockley
Keyword(s):  
High Risk ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Saline Injection ◽  
Referral Centre ◽  
Specific Test ◽  
Joint Aspiration ◽  
Prosthetic Joint

AimsThe aim of this study was to establish the diagnostic accuracy of culture of joint aspirate with and without saline injection-reaspiration.Patients and MethodsThis is a retrospective analysis of 580 hip and knee aspirations in patients who were deemed to have a moderate to high risk of infection, and who subsequently proceeded to revision arthroplasty over a period of 12 years. It was carried out at a large quaternary referral centre where preoperative aspiration is routine.ResultsFluid was aspirated primarily in 313 (54%) cases and after saline injection-reaspiration of a ‘dry tap’ in 267 (46%) cases. Overall sensitivity and specificity of the diagnostic aspirate were 84% (78% to 89%) and 85% (81% to 88%), respectively. Sensitivity and specificity of saline injection-reaspiration after ‘dry tap’ were 87% (79% to 92%) and 79% (72% to 84%) compared with 81% (71% to 88%) and 90% (85% to 93%) for direct aspiration.ConclusionPreoperative joint aspiration and culture is a sensitive and specific test for the confirmation of diagnosis in patients at a moderate to high risk of prosthetic joint infection. Culture of saline injection-reaspiration also provides accurate diagnostic information in the event of a ‘dry tap’. Both methods allow susceptibility testing of relevant organisms and are therefore able to guide perioperative antibiotic therapy. Cite this article: Bone Joint J 2018;100-B:749–54.

Sign in / Sign up

Export Citation Format

Share Document