Who Should Manage Periprosthetic Joint Infection? The Case for a Multidisciplinary Approach

Cover Page

Abstract

Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is a complex disease state that is quite devastating to those affected. Improvement in diagnostic testing modalities and therapeutic techniques have led to significant advances in treatment for patients, but there is still a considerable gap in treatment success across providers and institutions. Where and who should be treating cases of PJI remains a debated topic. Many experts have proposed a new treatment model not dissimilar to that with which has been used to treat other complex disease states such as cancer for decades, and there is now a growing body of evidence to support such a strategy is superior. In this article, we evaluate the current body of literature on the topic and offer recommendations for the ideal treatment model for PJI: the multidisciplinary approach.

About the authors

S. Yacovelli

Rothman Orthopedic Institute, Thomas Jefferson University Hospital

Author for correspondence.
Email: Steven.yacovelli@rothmanortho.com

Steven Yacovelli — MD, Researcher Fellow 

Department of Orthopedics

United States

J. Parvizi

Rothman Orthopedic Institute, Thomas Jefferson University Hospital

Email: fake@neicon.ru

Javad Parvizi — MD, Professor, Director of Clinical Research

Department of Orthopedics

United States

References

  1. Kurtz S.M., Lau E., Schmier J., Ong K.L., Zhao K., Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23(7):984-991. doi: 10.1016/j.arth.2007.10.017.
  2. Parvizi J., Tan T.L., Goswami K., Higuera C., Della Valle C., Chen A.F., Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018;33(5):1309-1314. e2. doi: 10.1016/j.arth.2018.02.078.
  3. Tetreault M.W., Estrera K.A., Kayupov E., Brander C., Della Valle C.J. Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? Arthroplasty Today. 2017;4(2): 216-220. doi: 10.1016/j.artd.2017.10.001.
  4. Armstrong M.D., Carli A.V., Abdelbary H., Poitras S., Lapner P., Beaulé P.E. Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis. Can J Surg. 2018;61(1): 34-41. doi: 10.1503/cjs.008617.
  5. Anderson M.B., Arciola C.R., Sarvanan S.A., Campoccia D., Certain L., Diaz-Ledezma C. et al. General Assembly, Treatment, Multidisciplinary Issues: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019;34(2S):S239-S243. doi: 10.1016/j.arth.2018.09.075.
  6. Son M.-S., Lau E., Parvizi J., Mont M.A., Bozic K.J., Kurtz S. What Are the Frequency, Associated Factors, and Mortality of Amputation and Arthrodesis After a Failed Infected TKA? Clin Orthop Relat Res. 2017;475(12): 2905-2913. doi: 10.1007/s11999-017-5285
  7. Dietz M.J., Springer B.D., Barnes P.D., Falciglia M., Friedrich A.D., Berendt A.R. et al. Best practices for centers of excellence in addressing periprosthetic joint infection. J Am Acad Orthop Surg. 2015;23 Suppl:S12-7. doi: 10.5435/JAAOS-D-14-00380.
  8. Ntalos D., Berger-Groch J., Rohde H., Grossterlinden L.G., Both A., Luebke A. et al. Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study. Arch Orthop Trauma Surg. 2019;139(4):467-473. doi: 10.1007/s00402-018-3079-6.
  9. Yan C.H., Arciola C.R., Soriano A., Levin L.S., Bauer T.W., Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev. 2018;6(4):e9. doi: 10.2106/JBJS.RVW.17.00058.
  10. Minassian A.M., Osmon D.R., Berendt A.R. Clinical guidelines in the management of prosthetic joint infection. J Antimicrob Chemother. 2014;69 Suppl 1:i29- 35.doi: 10.1093/jac/dku253.
  11. Ibrahim M.S., Raja S., Khan M.A., Haddad F.S. A multidisciplinary team approach to two-stage revision for the infected hip replacement: a minimum five-year follow-up study. Bone Joint J. 2014;96-B(10):1312-318. doi: 10.1302/0301-620X.96B10.32875.
  12. Petretta R., Phillips J., Toms A. Management of acute periprosthetic joint infection of the knee – Algorithms for the on call surgeon. Surgeon. 2017;15(2):83-92. doi: 10.1016/j.surge.2016.06.001.
  13. Kheir M.M., Tan T.L., George J., Higuera C.A., Maltenfort M.G., Parvizi J. Development and Evaluation of a Prognostic Calculator for the Surgical Treatment of Periprosthetic Joint Infection. J Arthroplasty. 2018;33(9):2986-2992.e1. doi: 10.1016/j.arth.2018.04.034.
  14. Jayakumar P., Moore M.L.G., Bozic K.J. Team Approach: A Multidisciplinary Approach to the Management of Hip and Knee Osteoarthritis. JBJS Rev. 2019;7(6):e10. doi: 10.2106/jbjs.rvw.18.00133.
  15. Akgün D., Müller M., Perka C., Winkler T. High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange. J Orthop Surg Res. 2019;14(1):78. doi: 10.1186/s13018-019-1122-0.
  16. Matar H.E., Stritch P., Emms N. Two-stage revisions of infected hip replacements: Subspecialisation and patient-reported outcome measures. J Orthop. 2019;16(2):179-181. doi: 10.1016/j.jor.2019.02.011.
  17. Bravo T., Budhiparama N., Flynn S., Gaol I.L., Hidayat H., Ifran N.N. et al. Hip and Knee Section, Prevention, Postoperative Issues: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019;34(2S):S321-S323. doi: 10.1016/j.arth.2018.09.017.
  18. Ravi B., Jenkinson R., Austin P.C., Croxford R., Wasserstein D., Escott B. et al. Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ. 2014;348:g3284. doi: 10.1136/bmj.g3284.
  19. Song S.Y., Goodman S.B., Suh G., Finlay A.K., Huddleston J.I. 3rd, Maloney W.J., Amanatullah D.F. Surgery Before Subspecialty Referral for Periprosthetic Knee Infection Reduces the Likelihood of Infection Control. Clin Orthop Relat Res. 2018;476(10):1995-2002. doi: 10.1097/corr.0000000000000423.
  20. Parvizi J., Shohat N., Gehrke T. Prevention of periprosthetic joint infection. Bone Joint J. 2017;99-B(4_Supple_B):3-10. doi: 10.1302/0301-620x.99b4.bjj-2016-1212.r1.

Statistics

Views

Abstract: 466

Cited-by

CrossRef: 2

  1. Tryapichnikov AS, Ermakov AM, Silantieva TA, Burtsev AV. Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip. Traumatology and Orthopedics of Russia. 2021;27(2):23. doi: 10.21823/2311-2905-2021-27-2-23-33
  2. Grishchuk AN, Leonova SN, Kameka AL. Using an Algorithm to Choose the Surgical Tactics for the Treatment of Periprosthetic Infection of Large Joints. Acta Biomedica Scientifica (East Siberian Biomedical Journal). 2021;5(6):199. doi: 10.29413/ABS.2020-5.6.24

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies