musculoskeletal and connective tissue disorders
Prosthetic Joint Infectious Arthritis
Treatment of Prosthetic Joint Infectious Arthritis
Arthrotomy with debridement Long-term systemic antibiotic therapy Treatment of prosthetic joint infection must be prolonged and usually involves arthrotomy for prosthesis removal with meticulous debridement of all cement, abscesses, and devitalized tissues. Debridement is followed by immediate prosthesis revision or placement of an antibiotic-impregnated spacer and then delayed (2 to 4 months) implantation of a new prosthesis using antibiotic-impregnated cement. Long-term systemic antibiotic therapy is used in either case; empiric therapy is initiated after intraoperative culture is done and usually combines coverage for methicillin-resistant gram-positive organisms (eg,vancomycin1 g IV every 12 hours) and aerobic gram-negative organisms (eg,piperacillin/tazobactam3.375 g IV every 6 hours orceftazidime2 g IV every 8 hours) and is revised based on results of culture and sensitivity testing. The overall rate of infection-free success at 5 years after combined medical and surgical treatment is 56%. If patients cannot tolerate surgery, long-term antibiotic therapy alone can be tried. Excision arthroplasty with or without fusion usually is reserved for patients with uncontrolled infection and insufficient bone stock. 