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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. May 25, 2017; 7(2): 11-20
Published online May 25, 2017. doi: 10.5495/wjcid.v7.i2.11
Management of periprosthetic infections
Félix Vilchez-Cavazos, Gregorio Villarreal-Villarreal, Victor Peña-Martinez, Carlos Acosta-Olivo
Félix Vilchez-Cavazos, Gregorio Villarreal-Villarreal, Victor Peña-Martinez, Carlos Acosta-Olivo, Orthopedics and Traumatology, Hospital Universitario “Dr. José E. Gonzalez”, Monterrey 64460, Nuevo Leon, Mexico
Author contributions: Vilchez-Cavazos F and Villarreal-Villarreal G wrote the paper; Peña-Martinez V and Acosta-Olivo C collected data and literature.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Félix Vilchez-Cavazos, MD, PhD, Professor of Orthopaedics and Traumatology, Hospital Universitario “Dr. José E. Gonzalez”, Francisco I. Madero y Av Gonzalitos S/N, Colonia Mitras Centro, Monterrey 64460, Nuevo León, Mexico. fvc78@hotmail.com
Telephone: +52-81-83476698
Received: August 27, 2016
Peer-review started: August 29, 2016
First decision: November 21, 2016
Revised: December 6, 2016
Accepted: January 20, 2017
Article in press: January 22, 2017
Published online: May 25, 2017
Processing time: 269 Days and 15 Hours
Abstract

Periprosthetic joint infection (PJI) is considered one of the most challenging complications compromising patient health and is considered an economic burden. Despite all strategies PJI prevalence is between 1%-2%. Considerable efforts have been investigated in the past decade to diminish or erradicate PJI prevalence. This article manages the definition of PJI and the new major and minor criteria from Parvizi et al Then a scientific analysis of every minor and major criteria. Multidisciplinary management is reccommended according to guidelines. A numerous of surgical options exist each and everyone with its indications, contraindications and specific antibiotic therapy regimen. Surgical options are: (1) irrigation and cleaning with retention of the prosthesis with a success rate 0%-89%; (2) single-stage revision surgery with a succes rate of > 80%; and (3) two-stage revision surgery (authors preferred method) with a succes rate of 87%. Radical treatment options like arthrodesis and amputation are reserved for specific group of patients, with a succes rate varying from 60%-100%. The future of PJI is focused on improving the diagnostic tools and to combat biofilm. The cornerstone of management consists in a rapid diagnosis and specific therapy. This article presents the most current diagnostic and treatment criteria as well as the different surgical treatment options depending on the type of infection, bacterial virulence and patient comorbidities.

Keywords: Periprosthesic joint infection; Arthroplasty; Arthrocentesis; Infection; Diagnosis; Staphylococcus aureus

Core tip: The total replacement surgery is a highly effective surgery that improves the quality of life of patients. The periprosthetic infection is considered a devastating complication that increases patients morbidity, mortality and an economic burden. The cornerstone of management consists in a rapid diagnosis and specific therapy. This article presents the most current diagnostic and treatment criteria, as well as the different surgical treatment options depending on the type of infection, bacterial virulence and patient comorbidities.