Debridement and Management of Prosthetic Joint Infection (PJI)
Duration of symptoms <3 weeks OR <30 days from arthroplasty AND
• No hardware loosening
• No sinus tracts
• Known pathogen susceptible to PO agents
Debridement & implant retention (DAIR)
• Duration:
- Staphylococci: 24wk for knees, otherwise 12wk
- Add rifampin if susceptible (or don’t if major DDIs/AEs)
- Fungus: don’t do DAIR
- Everything else: 12 weeks (based on 2021 DATIPO RTC)
• Chronic suppression: shared decision-making
- Should be exceptional/rare; no good data supporting practice
- S.aureus or MDRs, prior tx failure, limited life expectancy, poor candidacy for future surgeries all contribute to decision about whether benefit > risk
- Never “lifelong”: if suppressing, follow patient q6-12mo to assess med tolerance, discuss whether to continue therapy
Remove prosthesis:
• 2-stage exchange:
- Initial 6-12wk antibiotic therapy (12wk by DATIPO RTC)
- >2 week antibiotic holiday prior to revision arthroplasty; any s/sx of relapsed infection should prompt arthrocentesis or change of surgical plan to antibiotic spacer exchange
- Some groups trend ESR & CRP and/or do arthrocentesis on everyone before revision arthroplasty; data for this is poor
• 1-stage exchange - Antibiotics as per DAIR, though benefit of 12wk vs 6wk not clear
• Salvage methods: arthrodesis, amputation
- Antibiotic approach individualized based on extent of residual infected tissue/bone/metal
ID Chalk Talks by Nico Cortes-Penfield @Cortes_Penfield
#PJI #Prosthetic #Joint #Infection #treatment #Debridement #Management
