How is an infected joint prosthesis managed?
Early infections (<2–4 weeks postoperatively) with a well-fixed prosthesis can be managed with antibiotics (3–6 months) and open synovectomy, thorough debridement, and retention of the prosthesis. Multiple surgical debridements are often necessary. This is curative in up to 70% to 75% of patients.
Late infections usually present with only pain but can present with obvious sepsis of the involved joint. Once the diagnosis is made, treatment involves removal of prosthetic components, thorough debridement, and intravenous antibiotics for 6 weeks. If a low virulence organism is cultured, reimplantation with antibiotic-impregnated cement can be performed at 6 weeks. If Gram-negative organisms are cultured, a longer duration of resection arthroplasty is required (up to 12 months) before reimplantation. This two-stage resection arthroplasty with reimplantation is curative in 80% to 90% of patients.