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International Orthopaedics

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Open Access 01-01-2020 | Antibiotic | Review

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Authors: Cheng Li, Nora Renz, Andrej Trampuz, Cristina Ojeda-Thies

Published in: International Orthopaedics | Issue 1/2020

Abstract

Background

Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls.

Materials and methods

Common diagnostic and treatment errors are described, analyzed and interpreted.

Results

Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results.

Conclusion

Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.

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Title: Twenty common errors in the diagnosis and treatment of periprosthetic joint infection
Authors: Cheng Li
Nora Renz
Andrej Trampuz
Cristina Ojeda-Thies
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Antibiotic
Joint Infection
Published in: International Orthopaedics / Issue 1/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04426-7

At a glance: The STEP trials

Springer Medicine

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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