Early prosthetic joint infection after primary total joint arthroplasty: risk factors and treatment strategies

Abstract

Total knee and hip arthroplasty are highly successful surgical treatments for advanced osteoarthritis, although approximately 1-2% of these patients develops a prosthetic joint infection (PJI). To prevent the devastating effects of PJI, the studies in this thesis focused on patients at risk for PJI and factors that influence the outcome of PJI treatment. Although prolonged wound leakage is an important risk factor for PJI, there are no evidence-based guidelines on this topic. Our literature review showed that only few papers are available on prolonged wound leakage, which causes a wide variation in the diagnosis and treatment of prolonged leakage, as confirmed by our survey. Currently we are conducting a nationwide study to compare the efficacy of surgical and non-surgical treatment for prolonged wound leakage. Obese patients and oncology patients are also at increased risk for PJI. A literature review showed that there is a lack of evidence on oncologic PJI. Furthermore, we showed that PJIs in obese patients are caused by bacteria that are not covered by prophylactic antibiotics. Therefore, preventive strategies should be improved for obese patients. Regarding PJI treatment we showed that the outcome can be predicted by using the KLIC score. Furthermore, we found that applying local antibiotics in the joint cavity is associated with worse outcome and its use should therefore be discouraged. Finally, we found that the time from total joint arthroplasty to surgical debridement does not predict outcome, by which surgical debridement can be performed up to three months after joint arthroplasty.