Periprosthetic Joint Infection: Updated Practical Management Guide Javad Parvizi, Jonathan R Danoff, James F Fraser, R Andrew Henderson, Christopher P Bechtel, Asim M Makhdom
INDEX
Page numbers followed by b refer to box, f refer to figure, and t refer to table.
A
Abatacept 98
Abscess
localized skin 356
subperiosteal 277
Academy of Orthopaedic Surgeons 258
Accountable care organizations 53
Ace inhibitors 91
Acetabular component
insertion handle, device-specific 404f
separate backside of 403f
Acetabular fracture 117
Acetabular gouges, curved 401
Acetabular liner, screw removal of 402f
Acetabular osteotomes, curved 399f
Acid-fast bacilli 285, 335
Acinetobacter
baumannii 344
species 37
Actinomyces 359
infections 359
selective agar 360
Adalimumab 97, 98
Adverse metal reactions 305
AIBC See Antibiotic impregnated bone cement
Alcohol 169
abuse 61, 455
action of 169t
and drug use 66, 140
based iodophor 195
isopropyl 166
use 140
Allergenic potential, low 218
Allogenic blood 230
transfusion 235
Allopurinol 98
Alpha defensin 261
American Academy of Oral Medicine 47
American Academy of Orthopaedic Surgeons 47, 110, 249, 281, 286
clinical practice guidelines 147
American Association of Hip and Knee Surgeons 54
American College of Chest Physicians 148
American Dental Association 251
American Diabetes Association 71
American Society of Anesthesia 366
Aminoglycoside 26, 32, 350
Amoxicillin 207, 249, 357
Amphotericin B 32, 328
Ampicillin 250, 346, 349, 360
plus ceftriaxone 346
Anaerobic bacteria 31, 37
facultative 343
Anakinra 97
Anemia 131, 132
preoperative 46, 61, 66, 232
treatment of preoperative 231
Anesthesia
general 230
regional 232
Antibacterial properties 220
Antibiotic 227
cement 32
course of 286
dosage of 419
holiday 438
impregnated
bone cement 160, 218, 221t
suture 242
in cement 32
in intra-articular injection 32
infusion, intra-articular 378
laden bone cement 376
loaded
acrylic cement 429
bone cement preparation 224f
prophylaxis 157, 199, 251
resistance 226
emerging 346
sensitivities 284
spacer 416, 419t
suppression 450
of biofilm infection 38
Anticoagulation leading, excessive 66
Antifungal
cement spacer 330
drugs 328
Antimicrobial resistance 40
Antimicrobial therapy 336
Antiplatelet 91
Antirheumatic drugs, disease-modifying 96, 160, 300
Aortic arteries, stenting of 137
Arterial bypass 137
Arteritis 455
Arthritis
inflammatory 302, 302t, 311
noninflammatory 302t
Arthropathy, inflammatory 66, 96
Arthroplasty 21, 106, 126, 133, 243, 375f
metal-on-metal 306
one-stage exchange 370, 372
procedures, number of septic revision 372
resection 383, 384, 388t
two-stage exchange 370, 416
Arthroscopic debridement 366
Aseptic loosening 40
revision for 18b
Aspergillus species 325
Aspirin 91, 147, 148
Asymptomatic bacteriuria 110
Atrophy, disuse 386
Australian National Joint Replacement Registry 11
Autologous blood donation 232
Azathioprine 98
Aztreonam 29
B
Bacitracin 212, 213
Bacteremia 208
high risk of 251
Bacteria, interaction with 471
Bacterial adherence 242
Bacterial attachment to surfaces 38
Bacterial biofilm 42
Bacterial cells, community of 37
Bacterial contamination, retrograde 320
Bacterial cultures 31
Bacterial shedding 39
Bacteriophages 42
Benzodiazepines 94
Benzylpenicillin 356
Beta blockers 91
Biofilm 37
formation 242, 364
infections 468
maturation 39
Biological response modifiers 98
Blood
conservation 230
culture vials 288
donation, history of 230
flow phase 279
loss
major 71
reduce 234
pool phase 279
salvage
intraoperative 232
system 232
transfusion 133, 161
postoperative 66
Bloody aspirates 314
Body mass index 417
Bone
adjacent 275
cement 218
defects 440
diaphyseal 117
infected 385
scan 278
subperiosteal 276
Bone-prosthesis interface 286
British Society for Rheumatology 99
BT See Blood transfusion
Burkholderia pseudomallei 356
C
Calcium channel blockers 91
Canadian Diabetes Association 71
Candida
albicans 325, 326
glabrata 325
parapsilosis 325
species 37, 325, 326
tropicalis 325
Capreomycin 336
Carbapenems 26
Carbide burr 407f
Carbohydrate residues on exterior 32
Carbon monoxide gas 80
Cardiac surgery 243
Castille soap 213
Cefazolin 27, 32, 200, 202, 219, 250
dose of 250
Cefepime 27
Cefixime 27
Cefotaxime 32
Ceftaroline fosamil 27
Cefuroxime 27, 219, 250
Cell
membranes, disrupts 169
saver 232
tagged 279
Cellular glucose metabolism 280
Cellular immunity, decreased 326
Cellulitis 112
Cement and antibiotics 218
Cement osteotomes 399f
Cement reconstruction 379
Cemented acetabular polyethylene components 404
Cementless femoral component, removal of 405
Cementless reconstruction 379
Center for Disease Control 4, 5, 76
and Prevention 156, 165, 179, 230
Cephalexin 249
Cephalosporin 32, 207
Cephradine 249
Certolizumab 98
Charlson comorbidity index 46, 230
score 10
Chemoprophylaxis, postoperative 147
Chest pain 201
Chlorhexidine 168, 169, 213, 169t
gluconate 166, 211
skin 170
Chronic infection, one-stage revision for 379
Cilastatin 26
Ciprofloxacin 29, 32, 219, 447
Cirrhosis 125, 126
Clavulanic acid 357
Cleocin 219
Clindamycin 28, 32, 219, 356, 448
Clopidogrel 91
Clostridium difficile 200
Cloxacillin 26
Coagulase-negative Staphylococcus 13
Colchicine 98
Complete blood count 132, 133
Computer tomography scan 277
Concomitant infections, perioperative management of 110
Concurrent cellulitis 112
Congestive heart
disease 46
failure 61
Contractures 386
Coronary artery disease 80
Coronary heart disease 45
Corticosteroid 96
injections 86
intra-articular 85
Corynebacterium 357
Cotrimoxazole 357
Coxarthrosis, advanced 383
C-reactive protein 4, 6, 104, 258, 269, 276, 300, 302, 355, 455, 468
concentration 326
elevated 3
CRP See C-reactive protein
Crystalline
arthropathies 300
deposition disease 302
Culture and molecular methods 263
Culture principles 284
Culture swabs 287
Cycloserin 336
Cytotoxic potential 218
D
Dakin's solution 213
Dalbavancin 30
Dalfopristin 30
Daptomycin 28, 32, 346
Daptomycin-resistant Enterococcus 349
Decubitus ulcers 386
Deep tissue samples 286
Deep vein thrombosis 151, 232
prophylaxis 323
Deep venous thrombosis 70, 151
Dementia 145
Denatures proteins 169
Dental
abscess 46
clearance 111
disease, prevalence of 47
infection 66
prophylaxis 249
Depression 46, 61, 66, 144
Diabetes 61, 462, 470
mellitus 45, 46, 66, 69
perioperative management of 69
poorly controlled 366
Dialysis 46
Diarrhea 448
Diuretics 91
Doxycycline 356, 448
Drain use 245
Drug-resistant
organisms 455
treatment of multiple 336
E
Echinacea 92
Echogenicity, internal 277
Endocrine 92
Enterobacter spp 37, 344
Enterococcal infections 343
Enterococcus
faecalis 344
faecium 343, 344
gallinarum 344
species 345
Enzyme-linked immunosorbent assay 335, 469
Erythema 447
Erythrocyte sedimentation rate 3, 4, 6, 104, 258, 276, 300, 302, 306, 455, 468
Erythromycin 28, 32
ESR See Erythrocyte sedimentation rate
Etanercept 97, 98
Ethambutol 336, 340
Ethionamide 336
Exacerbations, acute 145
Eyes wide open 440
F
Factor Xa inhibitors 150, 320
FDG-PET scan 280
Femoral arteries, stenting of 137
Femoral component, separate 406f
Femoral epiphysis, slipped capital 117
Fibrosis, radiation 455
Flare-up of disease 100
Fluconazole 328
Fluid aspirated 312
Fluoroquinolones 32, 201, 447
Foreign body reaction 240
Fungi 169, 294
types of 325
Fusidic acid 356, 448
Future therapeutic directions 41
G
Gatifloxacin 219, 448
Gentamicin 26, 32, 200, 219, 222, 223, 226, 227, 350, 471
Gigli saw 410
Ginseng 93
Girdlestone procedure 383
Girdlestone resection arthroplasty 383
Glucose 66
fasting 70
Glycemic control 69, 157
Glycolide 240
Glycopeptides 28
Golimumab 98
Gout agents 98
Gram negative organisms 376
Gram's stain 5, 264
and frozen sections 264
intraoperative 313
Gram-negative
bacilli 13, 31
bacteria 169
Gram-positive bacteria 169
Granulation tissue 212, 219
Group D Streptococcus 343
H
Hair removal 157
Handmade spacers 226
Harbor bacteria 242
Harris hip score 374
Healthy host 366
Heart
disease 46
valve 343
Hematoma 75, 320
formation, surgical site 66
Hemoglobin 131
levels 230
Hemolytic anemia 71
Hepatitis C 46, 125127
Herbal medicine 94
Hickman catheter 32
Hip 117, 419, 420
and knee aspiration, techniques for 269
ankylosis 383
arthroplasty 208, 363
arthroplasty components 398
removal of 400
aspiration 269, 271
advantage to 272
dysplasia 117
fracture 117
fusion 117
replacement, performance of 115
spacer, dynamic 424f
Hyaluronic acid injections 88
Hydrogen peroxide 213
Hydroxychloroquine 98
Hypercholesterolemia 61
Hypercoagulability 80
Hyperglycemia 69, 77
Hypericum perforatum 93
Hypersensitivity reaction, delayed 448
Hypertension 80
Hypotension 201, 233
Hypoxia, chronic 455
I
Ibuprofen 92
Iliac arteries, stenting of 137
Iliac spine, anterior superior 271
Imipenem 26
Immune deficiency 455
Immune system, stimulates 92
Immunosuppressive therapy 160
Implants modifications 471
Infection 319, 363
chronic 365
control, demonstrate higher 297
culture-negative 457
diagnosis of 255
eradicate 366
implant-associated 263
late-onset 249
nosocomial 343
prevention guidelines 156
revision procedures for 18b
risk of 225
signs of 293
surgical site 80, 119, 156, 165, 178, 199, 230
treatment failure of 458
Inflammatory biomarkers 300
Infliximab 97, 98
Ingrown stem 407f
Insulin 92
Interleukin-1 inhibitors 97
International consensus
group 4, 5, 7
meeting 160
International normalized ratio 64, 127, 322
Intestinal flora 343
Intra-articular fluid 282
Intra-articular injection 66, 86, 159, 234
Intravenous
antibiotics 346
cell 349
drug
abuse 141
use 141
Iodine povacrylex 195
Iodophors 169, 169t
Iron deficiency anemia 71, 231
Irrigation solution, type of 211
Isolate organism, strategies to 295
Isoniazid 336
J
Jehovah's witnesses 232
Joint
arthroplasty 52, 300
elective total 86
aspiration 269, 439
accuracy of 284
effusion 277
fluid 5
analysis 6
infection
evidence of 5
intra-articular 85
native 335
pain 5
reconstruction surgery 96
replacement 240
infected 372
ranges, primary 52
stiffness 386
tissue 335
K
Kidney
disease 123
chronic 66
injury, acute 422
Klebsiella species 37
Knee 118, 419, 420
amputation 385
arthroplasty 244, 245, 363
arthroplasty components 408
removal of 408
arthroplasty, bilateral 131
infection 363
reconstructive surgery 138
replacement, performance of 115
spacer 224f
failed dynamic 428f
failed static 426f
L
Lactide 240
Laminar airflow 158
systems 177
Leflunomide 98
Length of stay 9, 17
Leucopenia 448
Leukocyte 280
esterase 4, 260, 272, 440
test strip 260
infection-related 280
Levofloxacin 219, 447
Levothyroxine 92
Lincosamides 28
Linezolid 29, 219, 356, 448
Lipopeptides 28
inhibit protein 31
Liver
disease 123, 125
active 66
score, end-stage 126
failure 455
Low-molecular-weight heparin 147, 149
Lymphedema 45
chronic 455
M
MAC See Mycobacterium avium complex
Macrolides 28
Magnetic resonance imaging 281
Malnutrition 45, 66, 75
MCV See Mean corpuscular volume
Mean corpuscular volume 133
Medication management, perioperative 91t
Medicine
alternative 90
complementary 90
Meloxicam 92
Mental health
illnesses 144
issues, chronic 145
Metal artifact reduction 281
series 307
Metal-cutting burr 406
Metallic implants 281
Metastatic disease 465
Metastatic tumor 61
Methicillin-resistance 458
organism 20, 376
Staphylococcus aureus 30, 31, 158, 166, 200, 212, 365, 373
screening 159
Staphylococcus epidermidis 373
Methicillin-sensitive organisms 376
Methotrexate 98
Metronidazole 356
Microbial coverage 26t
Microbial cultures 284
Microcolony formation 38
Microorganism 364
Minocycline 448
Modular exchange 363
Molecular techniques 272
Monobactams 29
Monotherapy antibiotic regimen 349
Motor blockade 233
Moxifloxacin 356, 447
MRSA See Methicillin-resistant Staphylococcus aureus
MRSE See Methicillin-resistant Staphylococcus epidermidis
MTB See Mycobacterium tuberculosis
Multidrug-resistant organisms 458
Muscle circumference 76
Musculoskeletal Infection Society 3, 115, 257, 326, 451
Mycobacteria 294, 338t
Mycobacterial infection, management of 334
Mycobacterium
abscessus 334
avium complex 334, 340
chelonae 334
fortuitum 334
smegmatis 334
species 37
tuberculosis 14, 169, 334, 340
Myocardial infarction 46, 235
N
Nabumetone 92
Nafcillin 202
Naproxen 92
Nationwide inpatient sample 144, 463
Nebcin 219
Neomycin 213
Nephrotoxicity 448
Newer antifungal agents 329
Next generation sequencing 263, 469
Nitroglycerin 91
Noninflammatory arthritis 302
Nonoperative treatment 320
Nonsteroidal anti-inflammatory drugs 96, 98, 124
Normothermia 158
Novel next-generation therapies 41
NSAIDs See Nonsteroidal anti-inflammatory drugs
Nutritional deficiency 75
O
Obesity 45, 66, 75, 76
Obstructive pulmonary disease, chronic 80
Ofloxacin 447
Operating room
environment 177
traffic 180
Opioids 94
Oral
amoxicillin 360
antibiotic therapy 446
hypoglycemics 92
Organism identification 288
Oritavancin 30
Oscillating saw 410
Osteoarthritis 96
Osteomyelitis 281
Osteotomes 410
curved 403f
small rigid 399f
thin 412f
Oxazolidinones 29
Oxidation 169
Oxygenation 158
P
Pain 447
P-amino-salicylic acid 336
Panax quinquefolius 93
Patellar component 413f
removal of 413
Patellar tendon
abuts region of 426f
places pressure on 428f
Pencil-tipped burr, high-speed 406f
Penicillin 26, 32, 360
Peripheral vascular disease 46, 61, 80, 136
Periprosthetic fractures 276
Periprosthetic fungal infection 325
Periprosthetic hematoma 321
Periprosthetic hip 363
infection 375f
Periprosthetic infection, components for 407f
Periprosthetic joint infection 3, 3t, 4, 9, 17, 25, 45, 52, 61, 75, 80, 96, 102, 110, 123, 131, 140, 144, 156, 165, 269, 305, 309, 325, 334, 343, 348, 354, 363, 370, 383, 388t, 398, 408, 454, 462465, 467
and mortality 462
associated mortality, etiology of 462
classification for 454
culture-negative 293
diagnosis of 257, 275, 284, 305, 309
economic burden of 17
eradication of 446
in inflammatory conditions, diagnosis of 300
management of 45, 343
fungal 325
prevention of 61, 470
prophylaxis of 218
risk for 300
treatment of 19t, 45, 218, 225, 293, 317, 338t, 370, 398, 416, 462
Periprosthetic tissue 3
Peroneal nerve palsy 386
Pin-site infection 386
Piperacillin 219
Pituitary rongeurs 399f
PJI See Periprosthetic joint infection
Planktonic bacteria, isolation of 263
Plastic adhesive 194
PMN See Polymorphonuclear neutrophil
Pneumonia 386
Polydioxanone nanoparticles 471
Polyglycolic acid 471
Polymerase chain reaction 41, 263, 328, 335
Polymeric matrix, self-produced 37
Polymethyl methacrylate 218, 219, 330, 418
Polymicrobial infections 31, 343, 349, 376, 469
Polymixin 213
Polymorphonuclear cell 260, 302
Polymorphonuclear neutrophil 4, 39
Polymyxin 212
Polysaccharide intercellular adhesin 39
Postarthroplasty
antibiotic prophylaxis 249
joint infections 249
Povidine-iodine 213
Preprosthetic joint infection 205
Prior antimicrobial therapy 294
Prophylactic antibiotics 200, 298
Propionibacterium acnes 5, 37, 288, 354
diagnosis of 355
Propionibacterium species 295, 354
Prosthetic joint infection 147, 230, 251, 252, 446
diagnosis of 275, 468
treatment of 337
Proximal femur 383
Pruritus 233
Pseudomembranous colitis 448
Pseudomonas 365, 376
aeruginosa 37, 344
Psychiatric
condition 66
illnesses 144
Psychoses 46, 144, 145
Pulmonary circulation disorders 46
Pulmonary disease, chronic 61
Pulmonary embolism 131, 232
Pulmonary embolus 70
Pyrazinamide 336, 340
Q
Quality of life 372
Quantum dots fluorophore 470
Quinolones 29, 31
Quinupristin 30
Quorum quenching 41
Quorum sensing 39
R
Randomized controlled trials 170
Rapidly growing mycobacteria 334, 340
Reactions, hypersensitivity 226
Red-man syndrome 201
Red-neck syndrome 201
Reimplantation procedure 226
Renal disease 46, 61, 124, 128
end-stage 123
Renal failure 366, 455
acute 226
RGM See Rapidly growing mycobacteria
Rheumatoid arthritis 45, 61, 96, 100, 366
Rheumatologic diseases 45
Rhodotorula minuta 325
Rifampicin 356
Rifampin 29, 31, 219, 336, 340, 346, 448
Rifamycin 29
Rifapentine 336
Rituximab 98
Rivaroxaban 320
Rothman protocol 126, 132
S
Septic arthritis 86, 102, 103, 106
active 106
treatment of 383
Septic joint 66
Serology 311
Serum
D-dimer 262
markers 259
current 262
white blood cell 260
Sickle cell anemia 71
Sinus tract 384
communicating with joint 3
presence of 455
Skin
avulsion injuries 195
cleansing, preoperative 157
discoloration 448
infection 66
preparation, preoperative 165
sealant and drapes 159
Smoking 45, 46
Sodium hypochlorite 213
Soft tissue 275
compromise, local 455
superficial 321
Spacer, type of 419, 420, 428
Standard acetabular fixation screw 402f
Staphylococcus
aureus 12, 37, 199, 288, 297, 343, 365, 455, 457, 465, 469
hospital-acquired 165
infections 457
epidermidis 37, 166, 199, 288
species 297, 354
Static hip spacer 424f
Static knee spacer 425f, 427f
Statins 91
Steroid 94
therapy 455
Streptococcus
canis 358
dysgalactiae 358
species 354
Streptogramins 30
Streptomycin 336
Suboptimal nutritional states 75
Sulfasalazine 98
Supplements, herbal over-the-counter 92
Surgical site preparation 158
Surgical strategy 117
Suture
absorbable 240
barbed 243, 244
monofilament 241, 242
nonabsorbable 240, 241
polyfilament 241, 242
type of 160
Swelling 5, 447
Synovial aspirate 312, 313
Synovial biopsy 5
Synovial fluid 5, 272, 293, 440
analysis 104
aspiration 284, 285
C-reactive protein 272
culturing 288
Synovial polymorphonuclear percentage 326
Synovial white blood cells count 4
Synthetic response modifiers 98
Systemic antibiotic
administration, perioperative 107
prophylaxis 199
T
Tanacetum parthenium 93
Tazobactam 219
Teicoplanin 32
Tensile strength 242
Tetracycline 448
antibiotics 448
THA See Total hip arthroplasty
Thromboembolic complications 234, 236
risk for 234
Thromboembolic stroke 235
Tibial component 428f
from underlying cement 410f
Ticar 219
Ticarcillin 219
Ticlopidine 91
Tissue
abscess 278
cultures of 6, 293
intraoperative deep 286
irritation, chronic 240
layers 243
TJA See Total joint arthroplasty
Tobacco abuse 455
Tobramycin 32, 219, 220, 222, 224f, 227, 421
Tocilizumab 98
Total hip
and knee arthroplasty, conversion 120
arthroplasty 9, 17, 52, 86, 96, 103, 115, 144, 168, 202, 232, 259, 319, 348, 417, 464
Total joint arthroplasty 45, 69, 75, 80, 102, 123, 131, 140, 145, 147, 156, 165, 199, 230, 234, 259, 276, 383
irrigation solutions in 211
primary cemented 220
Total knee arthroplasty 9, 52, 86, 96, 103, 115, 136, 144, 168, 202, 319, 320, 417
Total white blood cells count 104
Tourniquet use 233
Tranexemic acid 234
Traumatic arthrocentesis 272
Trimethoprim-sulfamethoxazole 207, 448
Trochanteric osteotomy, extended 399
Tuberculous arthritis 106
Tumor necrosis
alpha inhibitors 97
factor 300
U
Ultraviolet light 179
Unfractionated heparin 147, 150
United States Food and Drug Administration 90
United States Nationwide Inpatient Sample 18
Upper extremities, weakness of 384
Urinary bacterial count 112
Urinary incontinence 46
Urinary retention 233
Urinary tract 66
infection 46, 110, 205, 386
Urine culture 206
V
Valvular disease 61
Vancocin 219
Vancomycin 28, 32, 200, 201, 219, 224f, 226, 346, 349, 350, 448, 463, 471
Vancomycin-resistant Enterococcus 345, 348, 458
Venous stasis 455
Venous thromboembolic events, prevention of 448
Venous thromboembolism 61, 147, 235
prophylaxis 148
Vessel compromise 455
Veterans affairs 140
Viruses 169
Vitamin
D 77
deficiency 77
Voriconazole 330
VRE See Vancomycin-resistant Enterococcus
W
Warfarin 151
WBC See White blood cell
White blood cell 4, 6, 260, 302
count 326
elevated synovial fluid 3
White cell 279
scan, tagged 279
World Health Organization 76
Wound
closure 240
complications 147, 161, 245
surgical 97
drainage 66
management of 319
dressing 160, 245
exploration 321
healing 80, 212
hematoma 245
infection, development of 245
irrigation 159
therapy, negative-pressure 321
Y
Yeast cells 325
Z
Zimmer explant system 401404
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Chapter Notes

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