Periprosthetic Infection: Management of Early Postoperative Infection View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2015

AUTHORS

Craig J. Della Valle , Erdan Kayupov

ABSTRACT

Deep periprosthetic joint infection (PJI) in the early postoperative period, defined as within the first 6 weeks postoperatively, is among the most dreaded complications following total knee arthroplasty. Diagnosis can be challenging as normal postoperative pain, swelling, and peri-incisional inflammation can cloud normal cues to diagnosis. Based on work from our center, we recommend the use of the serum C-reactive protein (CRP) as a screening test with an optimal threshold of approximately 100 mg/L (normal <10 mg/L); a value above or near this threshold should prompt an aspiration of the joint. Aspirated fluid should be sent for a synovial fluid white blood cell (WBC) count and differential, with optimal cutoff values during the first 6 weeks postoperatively of approximately 10,000 WBC/μ[mu]L and 90 %, respectively. In cases where the clinician is still unsure if a deep infection is present, synovial fluid cultures can be obtained and monitored, with the final decision on the treatment plan based on their results.Treatment of a deep periprosthetic joint infection is operative and typically includes an exchange of the modular bearing surface, in addition to meticulous debridement, irrigation, and closure of the wound. Unfortunately, results are less than optimal with a cure rate of approximately 50 % in most reports. In some situations the surgeon may decide to remove the implants as the first part of a two-stage exchange, particularly if the patient is a poor host, or if the organism is resistant to antibiotics and prone to biofilm formation (e.g., staphylococcal species). More... »

PAGES

81-89

Book

TITLE

Complex Primary and Revision Total Knee Arthroplasty

ISBN

978-3-319-18349-7
978-3-319-18350-3

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-18350-3_7

DOI

http://dx.doi.org/10.1007/978-3-319-18350-3_7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1038003399


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