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Slullitel PA, Oñativia JI, Buttaro MA, et al. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev. 2018;3(7):434-441doi: 10.1302/2058-5241.3.170032.
Slullitel, P. A., Oñativia, J. I., Buttaro, M. A., Sánchez, M. L., Comba, F., Zanotti, G., & Piccaluga, F. (2018). State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT open reviews, 3(7), 434-441. https://doi.org/10.1302/2058-5241.3.170032
Slullitel, Pablo A, et al. "State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty." EFORT open reviews vol. 3,7 (2018): 434-441. doi: https://doi.org/10.1302/2058-5241.3.170032
Slullitel PA, Oñativia JI, Buttaro MA, Sánchez ML, Comba F, Zanotti G, Piccaluga F. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev. 2018 Jul 17;3(7):434-441. doi: 10.1302/2058-5241.3.170032. eCollection 2018 Jul. PMID: 30233819; PMCID: PMC6129958.
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EFORT Open Rev. 2018 Jul 17;3(7):434-441. doi: 10.1302/2058-5241.3.170032. eCollection 2018 Jul.

State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty.

EFORT open reviews

Pablo A Slullitel, José I Oñativia, Martin A Buttaro, Marisa L Sánchez, Fernando Comba, Gerardo Zanotti, Francisco Piccaluga

Affiliations

  1. Hip Surgery Unit, Italian Hospital of Buenos Aires, Argentina.
  2. Infectology Department, Italian Hospital of Buenos Aires, Argentina.

PMID: 30233819 PMCID: PMC6129958 DOI: 10.1302/2058-5241.3.170032

Abstract

Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potentially devastating and undesired complication, with a prevalence of 0.3% to 2.9%. Its suspicion begins with a meticulous physical examination and anamnesis. Diagnosis should be made on the basis of the Musculoskeletal Infection Society criteria. Serum and synovial biomarkers are very useful tools when major criteria are absent.Although sometimes not possible due to medical conditions, surgery is usually the first line of treatment. Although its outcome is highly correlated with the isolated microorganism, irrigation and debridement with implant retention (DAIR) is the gold standard for treatment. Ideally, the prior approach should be proximally and distally extended to augment the field of view and remove all of the prosthetic modular components, that is, femoral head and acetabular insert.Given DAIR's unclear control of infection, with successful outcomes in the range of 30% to 95%, one- or two-stage revision protocols may play a role in certain cases of acute infections; nonetheless, further prospective, randomized studies are necessary to compare long-term outcomes between DAIR and revision surgeries.Following surgical treatment, length of antibiotherapy is in the range of six weeks to six months, without any difference in outcomes between short and long protocols. Treatment should be adjusted to the isolated bacteria and controlled further with post-operative serum biomarker levels. Cite this article:

Keywords: acute peri-prosthetic joint infection; implant retention; irrigation and debridement; serum biomarkers; synovial biomarkers; total hip arthroplasty

Conflict of interest statement

ICMJE Conflict of interest statement: None declared.

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