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Diagnosis & Treatment Options for Periprosthetic Joint Infections

A periprosthetic joint infection is one of the most challenging complications after hip or knee arthroplasty. It’s also one of the most concerning, since delaying treatment can lead to impaired joint function, among other serious health problems.

Dr. Jose Rodriguez is the Chief of Reconstruction Arthroplasty and the Director of the Arthroplasty Fellowship Program at Lenox Hill Hospital.


What is a periprosthetic joint infection?

In the simplest terms, a periprosthetic joint infection (PJI) is an infection in the implantation site of a prosthetic joint.


What are the risk factors for an infection in a prosthetic joint?

The biggest risk factors for developing an infection in a prosthetic joint include:

  • Having had a previous joint arthroplasty
  • An infection in the surgical site not involving the actual prosthesis (the infection may migrate)
  • Presence of a malignancy

Other risk factors may include:

  • Your age (the older you are, the higher your risk)
  • Having type 2 diabetes
  • Having previously had a joint infection
  • Obesity
  • Sub-optimal nutrition
  • Having certain skin diseases (e.g. chronic dermatitis, like psoriasis)
  • Suffering from a pre-existing joint disease, such as rheumatoid arthritis

In general, patients who are having a revision of an existing artificial joint are much more at risk than those who are having a joint replacement for the first time.


How is a periprosthetic joint infection diagnosed?

Diagnosing a periprosthetic joint infection can be challenging, in part because there is no “gold standard” of diagnosis. While you might assume this would be simple—no more than testing a sample of tissue or fluid from the joint for the presence of harmful bacteria—the problem is more complex. This type of testing can result in both false negative results (where there is an infection, but no bacteria shows up in the culture) and false positive ones (where bacteria is present in the culture, but not in the joint itself) at the rate of 5-7 percent. The lack of clear diagnostic criteria makes it challenging to differentiate cases where the joint has failed due to an infection (septic failure) from those cases where the joint fails for other reasons (aseptic failure).

A PJI may be present if:

  • There is a “tunneling wound” or an opening through the tissue surrounding the prosthesis (this can be, or may become, an abscess)
  • Two separate samples of either tissue, fluid, or both from the area are shown to contain harmful bacteria
  • Four or more of the following criteria are met:
    • A serum erythrocyte sedimentation or serum C-reactive protein test shows that there is inflammation
    • You have an elevated white blood cell count in the synovial fluid of the joint
    • You have elevated levels of neutrophils (a type cell which fights infection) in the synovial fluid
    • The joint contains pus
    • Harmful bacteria are present in one sample of joint fluid or tissue
    • The number of neutrophils in a tissue sample is above a certain number


What are the treatment options?

Along with diagnosis, treatment for periprosthetic joint infections is also complex and challenging. Effective treatment of a PJI generally requires both appropriate surgery and antibiotics. Care may often involve a multidisciplinary team that may include:

  • Orthopedic surgeons
  • Plastic surgeons
  • Microbiologists
  • Infectious disease specialists
  • Physiotherapists or occupational therapists

Choosing an orthopedic joint reconstruction surgeon with extensive experience in treating this type of case is vital, especially if the infection is especially complex or of long duration. Each patient’s case is unique, which is why it is critically important to be treated by a well-trained physician who can determine the most appropriate surgical treatment for your situation.


Where can I find periprosthetic joint infection treatment in NYC?

Dr. Rodriquez is a fellowship-trained orthopedic surgeon who specializes in the treatment of traumatic and developmental conditions of the hip and knee. Dr. Rodriguez is skilled in arthroscopy, total joint replacement and revisions as well as fracture surgery.

Periprosthetic joint infections require specialized care from an experienced orthopedic surgeon. If you believe you’re suffering from a periprosthetic joint infection, schedule a consultation with Dr. Rodriguez, a recognized expert in the field.

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