Del Pozo and Patel reported an algorithm for the management of a patient with a prosthetic joint infection. The authors are from the Mayo Clinic.
Parameters:
(1) suitability of the patient for re-operation
(2) functional improvement expected if the prosthesis is exchanged
(3) failure of multiple previous attempts to cure the infection
(4) clinical factors favorable to clearance of the infection with antibiotic therapy (see below)
Clinical factors - all of the following:
(1) symptoms present < 3 weeks
(2) impant stable
(3) (joint in place < 3 months) OR (hematogenous route of infection)
(4) organism susceptible to antibiotic therapy (not multidrug resistant bacteria, not fungus, not Enterococcus, not quinolone-resistant Pseudomonas aeruginosa, not small colony variant of Staphylococcus aureus)
|
Suitability for Reoperation |
Expected Improvement AND/OR Previous Failures |
Favorable Clinical Factors Present |
Option |
|
N |
NA |
NA |
A |
|
Y |
N OR Y |
NA |
B |
|
Y |
Y AND N |
Y |
C |
|
Y |
Y AND N |
N |
D |
|
Option |
Management |
|
A |
palliative approach with long-term antimicrobial therapy |
|
B |
remove implant without replacement; continued antimicrobial therapy; amputation if infection uncontrolled |
|
C |
debride tissue; retain prosthesis; antimicrobial therapy |
|
D |
replace prosthesis (one or two stage approach); antimicrobial therapy |
Specialty: Infectious Diseases, Surgery, orthopedic
ICD-10: ,
