How are prosthetic joint infections treated? What measures can be done to prevent them?
1. Debridement, antibiotics, and implant retention (DAIR): considered for patients with a well-fixed prosthesis without a sinus tract who develop infection in first 30 days after prosthesis implantation or with less than 3 weeks of infectious symptoms. Treated for 6 weeks with IV antibiotics followed by oral antibiotics to complete a total of 3 months of antimicrobial therapy for total hip arthroplasty or a total of 6 months of antimicrobial therapy for all other joints. Consideration for lifelong oral suppression to be based on patient and microbial factors. Success rates of 14% to 100%.
2. One-stage replacement: removal of prosthesis, washout, and immediate placement of new prosthesis. Performed more frequently in Europe than in the United States. Can be considered when a good soft tissue envelope is present and the infecting pathogen is known preoperatively. Antimicrobial therapy the same as for DAIR. Success rate 70% to 90%.
3. Two-stage replacement: 1) prosthesis and cement removal with stabilization of joint using an antibiotic-impregnated spacer, followed by 6 weeks systemic antibiotics, followed by 2) reimplantation after completion of antimicrobial therapy. Success rate 90% to 97%.
Pearl: Rifampin is often added to the antibiotic regimen to penetrate biofilms for infections caused by susceptible S taphylococci.
