Multispecialty physician teams need to work together to reduce disability, death and costs associated with the ever-growing number of prosthetic joint infections, according to the first guidelines on the topic by the Infectious Diseases Society of America (IDSA).
Joint infections require multidisciplinary teams, including an orthopedist and an infectious disease specialist, as well as other specialists, such as internists or plastic surgeons, on a case-by-case basis, the guidelines say. In rural areas with few specialists, doctors should consider consulting with infectious disease specialists or orthopedists at referral centers. The guidelines were published online Dec. 6 by Clinical Infectious Diseases and appeared on the IDSA website.
Physicians should suspect a prosthetic joint infection in a patient who has any of the following:
- sinus tract or persistent wound drainage in the skin over the joint replacement,
- sudden onset of a painful prosthesis, or
- ongoing pain at any time after the prosthesis has been implanted, especially in the absence of a pain-free interval, in the first few years after implantation or if there is a history of prior wound healing problems or infections.
The following guidelines apply in patients with prosthetic joint infections:
- Those with a well-fixed prosthesis without a sinus tract who had surgery less than 30 days previously or who have had infectious symptoms for less than three weeks should be considered for debridement with retention of prosthesis.
- Those who have more extensive infection that has affected the bone and tissue may need to have the prosthesis replaced, either in the same surgery in which the prosthesis is removed or in a later surgery.
- Patients who cannot walk and who have limited bone stock, poor soft tissue coverage, and infections due to highly resistant organisms, may need to have the implants permanently removed. In some cases the joint may need to be fused.
- Amputation of the limb may be necessary, but only as a last resort. Prior to amputation, the patient should be referred to a center with specialist experience in prosthetic joint infections except in emergent cases.
Four to six weeks of pathogen-specific intravenous or highly bioavailable oral antibiotic therapy following resection arthroplasty is recommended to treat prosthetic joint infections, according to the guidelines.