Diagnosis and management of infected arthroplasty

Periprosthetic joint infection (PJI) is one of the most dreadful complications after THA and TKA. Though prevention is of utmost importance in PJI management, the last decade has seen many remarkable developments in PJI diagnosis, including the introduction of several standardized PJI diagnostic def...

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Autores principales:	Pannu Tejbir S., Villa Jesus M., Higuera Carlos A.
Formato:	article
Lenguaje:	EN
Publicado:	EDP Sciences 2021
Materias:	pji periprosthetic joint infection infected arthroplasty diagnosis of pji treatment of pji Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/ef43701e8ea941e3b7a58b44a9f5c9fa
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spelling	oai:doaj.org-article:ef43701e8ea941e3b7a58b44a9f5c9fa2021-11-12T11:45:41ZDiagnosis and management of infected arthroplasty2426-888710.1051/sicotj/2021054https://doaj.org/article/ef43701e8ea941e3b7a58b44a9f5c9fa2021-01-01T00:00:00Zhttps://www.sicot-j.org/articles/sicotj/full_html/2021/01/sicotj210017/sicotj210017.htmlhttps://doaj.org/toc/2426-8887Periprosthetic joint infection (PJI) is one of the most dreadful complications after THA and TKA. Though prevention is of utmost importance in PJI management, the last decade has seen many remarkable developments in PJI diagnosis, including the introduction of several standardized PJI diagnostic definitions and biomarkers. Depending on the specific clinical situation, a myriad of treatment options for PJI are offered. Our review aims to summarize the pertinent information on PJI diagnosis and synthesize literature on the different treatment methods currently used in clinical practice. One of the most accepted PJI diagnostic definitions was developed by the Musculoskeletal Infection Society (MSIS) in 2011, later modified in the 2013 International Consensus Meeting (ICM). After promising results from studies, alpha-defensins and D-dimer were recently incorporated into the 2018 ICM PJI definition. The management choices for PJI include irrigation and debridement (DAIR), one-stage exchange arthroplasty, or two-stage exchange arthroplasty, to name a few. While two-stage revision has traditionally been the treatment of choice in the United States, there has been a growing body of evidence framing one-stage revision as a comparable choice. One-stage revision should be offered in patients meeting strict selection criteria: no sinus tract, proper soft tissue available for wound closure, appropriate bone stock, a favorable identifiable organism with encouraging antibiotic sensitivities (for cement and oral suppression later), and robust immunological status. DAIR can be considered in case of early infections with sensitive infecting organisms. Patients with multiple unsuccessful revisions or those who refuse further surgical intervention for PJI can be offered antibiotic suppression. If nothing seems to work, salvage procedures (resection arthroplasty and arthrodesis) are available as a last resort. Further research is encouraged to improve on diagnostic capabilities and develop evidence on the best treatment of choice for PJI.Pannu Tejbir S.Villa Jesus M.Higuera Carlos A.EDP Sciencesarticlepjiperiprosthetic joint infectioninfected arthroplastydiagnosis of pjitreatment of pjiOrthopedic surgeryRD701-811ENSICOT-J, Vol 7, p 54 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pji periprosthetic joint infection infected arthroplasty diagnosis of pji treatment of pji Orthopedic surgery RD701-811
spellingShingle	pji periprosthetic joint infection infected arthroplasty diagnosis of pji treatment of pji Orthopedic surgery RD701-811 Pannu Tejbir S. Villa Jesus M. Higuera Carlos A. Diagnosis and management of infected arthroplasty
description	Periprosthetic joint infection (PJI) is one of the most dreadful complications after THA and TKA. Though prevention is of utmost importance in PJI management, the last decade has seen many remarkable developments in PJI diagnosis, including the introduction of several standardized PJI diagnostic definitions and biomarkers. Depending on the specific clinical situation, a myriad of treatment options for PJI are offered. Our review aims to summarize the pertinent information on PJI diagnosis and synthesize literature on the different treatment methods currently used in clinical practice. One of the most accepted PJI diagnostic definitions was developed by the Musculoskeletal Infection Society (MSIS) in 2011, later modified in the 2013 International Consensus Meeting (ICM). After promising results from studies, alpha-defensins and D-dimer were recently incorporated into the 2018 ICM PJI definition. The management choices for PJI include irrigation and debridement (DAIR), one-stage exchange arthroplasty, or two-stage exchange arthroplasty, to name a few. While two-stage revision has traditionally been the treatment of choice in the United States, there has been a growing body of evidence framing one-stage revision as a comparable choice. One-stage revision should be offered in patients meeting strict selection criteria: no sinus tract, proper soft tissue available for wound closure, appropriate bone stock, a favorable identifiable organism with encouraging antibiotic sensitivities (for cement and oral suppression later), and robust immunological status. DAIR can be considered in case of early infections with sensitive infecting organisms. Patients with multiple unsuccessful revisions or those who refuse further surgical intervention for PJI can be offered antibiotic suppression. If nothing seems to work, salvage procedures (resection arthroplasty and arthrodesis) are available as a last resort. Further research is encouraged to improve on diagnostic capabilities and develop evidence on the best treatment of choice for PJI.
format	article
author	Pannu Tejbir S. Villa Jesus M. Higuera Carlos A.
author_facet	Pannu Tejbir S. Villa Jesus M. Higuera Carlos A.
author_sort	Pannu Tejbir S.
title	Diagnosis and management of infected arthroplasty
title_short	Diagnosis and management of infected arthroplasty
title_full	Diagnosis and management of infected arthroplasty
title_fullStr	Diagnosis and management of infected arthroplasty
title_full_unstemmed	Diagnosis and management of infected arthroplasty
title_sort	diagnosis and management of infected arthroplasty
publisher	EDP Sciences
publishDate	2021
url	https://doaj.org/article/ef43701e8ea941e3b7a58b44a9f5c9fa
work_keys_str_mv	AT pannutejbirs diagnosisandmanagementofinfectedarthroplasty AT villajesusm diagnosisandmanagementofinfectedarthroplasty AT higueracarlosa diagnosisandmanagementofinfectedarthroplasty
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Diagnosis and management of infected arthroplasty

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