Secondary prosthetic joint infection: diagnostic criteria, treatment

Per-operative contamination is the most frequent cause of prosthetic joint infection. in other cases, hematogenous contamination, which may be symptom -free, is responsible for secondary infection, which is the best-suited des ignation. Several factors, either isolated or combined, are important in es tablishing this diagnosis: prolonged symptom-free interval, bacterial agent not usually encountered in per-operative infections, remote focal infectio n site, positive blood cultures, identical bacteria isolated from both the prosthesis and the remote focal infection site or blood cultures. Infection may be acute or chronic and leads to mechanical failure. Patient history o ften reveals a neglected acute transient episode. Bacterial diagnosis is ma ndatory before initiating antibiotic therapy. Surgical management includes open irrigation, synovectomy, and debridement of any suspect tissue. Preser ving the prosthesis should be attempted. Local antibiotic treatment has not been proven effective. After a lapse of 21 days, prosthetic material shoul d be removed, bone interface should be scrubbed, and one- or two-stage re-i mplantation should be performed. Investigation and treatment of portal of e ntry should be initiated without delay. Prevention of secondary infection c onsists mainly in investigating and treating all focal infections. Any inva sive procedure, with or without implantation of foreign devices, may be inc riminated. The benefits Versus risks provided by an antibiotic prophylaxis have not been documented. (C) 2001 Editions scientifiques et medicales Else vier SAS.