Abstract
BackgroundElective knee and hip arthroplasty is followed by infections in currently about 0.5–2.0 % of cases – a figure which is on the increase due to the rise in primary implants. Correct diagnosis early on is essential so that appropriate therapy can be administered. This work presents a retrospective analysis of the diagnoses of patients suffering infections after total hip or knee arthroplasty.Methods320 patients with prosthetic joint infection (PJI) following knee or hip arthroplasty were identified. They comprised a) 172 patients with an infection after total hip arthroplasty (THA): 56 % females (n = 96) and 44 % males (n = 76) with a mean age of 70.9 (39–92) years; and 148 patients with an infection after total knee arthroplasty (TKA): 55 % females (n = 82) and 45 % males (n = 66) with a mean age of 70.7 (15–87) years.ResultsAlthough significantly more TKA than THA patients reported pain, erythema, a burning sensation and swelling, no differences between the two groups were observed with respect to dysfunction, fever or fatigue. However, significant differences were noted in the diagnosis of loosening (THA 55 %, TKA 31 %, p < 0.001) and suspected infection using conventional X-rays (THA 61 %, TKA 29 %, p < 0.001). FDG-PET-CT produced very good results in nearly 95 % of cases. There were no differences between THA and TKA patients regarding levels of inflammation markers. Histological evaluation proved to be significantly better than microbiological analysis.SummaryThe clinical picture may be non-specific and not show typical inflammatory symptoms for a long time, particularly in PJI of the hip. As imaging only provides reliable conclusions after the symptoms have persisted for a long time, morphological imaging is not suitable for the detection of early infections. FDG-PT-CT proved to be the most successful technique and is likely to be used more frequently in future. Nevertheless, there are currently no laboratory parameters which are suitable for the reliable primary diagnosis of PJI. Diagnosis requires arthrocentesis, and the fluid obtained should always be examined both microbiologically and histologically.
Highlights
Hip and knee replacements are among the most common operations worldwide
High expectations are attached to arthroplasty, which has been described as the operation of the century [3] due to its high success rate
Reflecting the quantity of primary joint replacements, the number of infections diagnosed in the US has steadily increased: between 1990 and 2004, the number of hip arthroplasty infections more than tripled while knee arthroplasty infections increased almost six-fold [5]
Summary
Hip and knee replacements are among the most common operations worldwide. The quantity performed is increasing significantly in response to demographic change. The amount of primary total knee arthroplasties (TKA) grew 1.7-fold from 135,992 to 237,645 [1,2]. Infections occur more rarely, they are one of the most feared complications and are potentially fatal. Reflecting the quantity of primary joint replacements, the number of infections diagnosed in the US has steadily increased: between 1990 and 2004, the number of hip arthroplasty infections more than tripled while knee arthroplasty infections increased almost six-fold [5]. Elective knee and hip arthroplasty is followed by infections in currently about 0.5–2.0 % of cases – a figure which is on the increase due to the rise in primary implants. This work presents a retrospective analysis of the diagnoses of patients suffering infections after total hip or knee arthroplasty
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
