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Periprosthetic Joint Infection: Practical Management Guide
Javad Parvizi, Glenn J Kerr, Aaron Glynn, Carlos A Higuera
SECTION 1: BASICS OF INFECTION
CHAPTER 1:
Defining Periprosthetic Joint Infections
Current Evidence
Controversies
CHAPTER 2:
Incidence and Burden of Periprosthetic Joint Infections
Incidence and Burden: United States
Incidence and Burden: Europe and Australia
Organism Profile
CHAPTER 3:
Economics of Periprosthetic Joint Infection
Current Evidence
Looking Ahead
Acknowledgment
CHAPTER 4:
Antibiotics and Periprosthetic Joint Infection: Basic Science
CHAPTER 5:
The Role of Biofilm in Periprosthetic Joint Infection
Current Evidence
Bacterial Attachment to Surfaces
Microcolony Formation
Biofilm Maturation
Bacterial Shedding
Antimicrobial Resistance
CHAPTER 6:
Multidisciplinary Approach and Management of Patients with Periprosthetic Infections
Current Evidence
PJI: Prevention
PJI: Treatment
Controversies
CHAPTER 7:
Periprosthetic Joint Infection: Future Trends and Challenges
Current Evidence
Controversies
What Effect will PJI have on Future THA and TKA Utilization?
What Effect will PJI have on the Patient's Selection of the Provider for Replacement Surgery?
What Effect will PJI have on Tertiary and Teaching Hospitals?
SECTION 2: PREVENTION
CHAPTER 8:
Predisposing Factors for Periprosthetic Joint Infection
Current Evidence
CHAPTER 9:
Patient Medical Optimization
Current Evidence
Drugs with Antiplatelet Effects1
Supplements7
Rheumatologic Agents7
Controversies
CHAPTER 10:
Preoperative Diabetic Maintenance and Control
Current Evidence
Controversies
CHAPTER 11:
Preoperative Skin Preparation: Decolonization and Antisepsis
Introduction
Current Evidence
Controversies
Conclusion
CHAPTER 12:
Controversial Preventive Strategies
Current Evidence
Introduction
Knife Blade Change
Triple Gloving
Autologous Blood-Derived Product Application to the Wound
Local Antibiotic Prophylaxis: Antibiotic Cement, Vancomycin Powder, Implant and Bone Graft Coating
Conclusion
CHAPTER 13:
The Operating Room Environment
Current Evidence
Laminar Airflow Systems
CDC Guidelines20
Ultraviolet Light
CDC Guideline20
OR Traffic
CDC Guideline20
Surgical Attire
Equipment and Surfaces
Physical Properties
CHAPTER 14:
Incise Drapes
Current Evidence
CHAPTER 15:
Antibiotic Prophylaxis
Current Evidence
Length of Coverage
Indications for Vancomycin
CHAPTER 16:
Workup of Patients with Suspected Urinary Tract Infection
Current Evidence
Controversies
CHAPTER 17:
Irrigation Solutions in Total Joint Arthroplasty
Current Evidence
Controversies
CHAPTER 18:
Bone Cement and Antibiotics
Current Evidence
Rationale for Antibiotic-Impregnated Bone Cement Use
Suitable Antibiotics for Use in PMMA
AIBC in Primary Cemented TJA
AIBC for PJI Treatment
Disadvantages of Routine Use of AIBC
Controversies
CHAPTER 19:
Blood Conservation
Current Evidence
Minimally Invasive Techniques and Expeditious Surgery
Tourniquet Use
Tranexamic Acid
Controversies
CHAPTER 20:
Wound Closure
Current Evidence
Absorbable Versus Nonabsorbable Sutures
Monofilament Versus Polyfilament Sutures
Antibiotic-Impregnated Sutures
Barbed Sutures
CHAPTER 21:
Drains
Current Evidence
Controversies
CHAPTER 22:
Postarthroplasty Antibiotic Prophylaxis
Current Evidence
Controversies
SECTION 3: DIAGNOSIS
CHAPTER 23:
AAOS Clinical Practice Guidelines: Diagnosis of Periprosthetic Joint Infections in Hip and Knee
Summary
Controversies
CHAPTER 24:
Available Diagnostic Laboratory Tests
Introduction
Current Evidence
Erythrocyte Sedimentation Rate and C-Reactive Protein
White Blood Cells and Polymorphonuclear Cells
Controversies
Gram Stain and Frozen Sections
CHAPTER 25:
Aspiration
Current Evidence
Techniques
Tests
Cell Count
Threshold for Chronic PJI
Threshold for Acute PJI
How to Adjust for Blood-Stained Fluid
Manual Versus Automated
Culture
Controversies
CHAPTER 26:
Molecular Markers in Periprosthetic Joint Infection
Current Evidence
Controversies
CHAPTER 27:
Imaging for Diagnosis of Periprosthetic Joint Infection
Current Evidence
Plain X-Ray and Computed Tomography Scan
Scintigraphic Studies
Flourine-18-Fluorodeoxyglucose Positron Emission Tomography
Magnetic Resonance Imaging
Controversies
CHAPTER 28:
Culture Principles
Current Evidence
Controversies
CHAPTER 29:
Culture-Negative Periprosthetic Joint Infection
Current Evidence
Strategies to Isolate Organism
Controversies
CHAPTER 30:
Diagnosis of Prosthetic Joint Infection in Inflammatory Conditions
Current Evidence
Controversies
CHAPTER 31:
Conditions Mimicking Periprosthetic Joint Infection
Current Evidence
Controversies
SECTION 4: TREATMENT OF PERIPROSTHETIC JOINT INFECTION
CHAPTER 32:
Total Joint Arthroplasty in Patients with Prior Septic Arthritis
Current Evidence
Introduction
Preoperative Evaluation
Intraoperative Strategies
Clinical Outcomes
Controversies
Conclusion
CHAPTER 33:
Joint Arthroplasty in Patients with Hardware In Situ
Current Evidence
One-Stage or Two-Stage Procedure
Surgical Strategy
Outcome
CHAPTER 34:
Management of Wound Drainage
Current Evidence
Background
Nonoperative Treatment
Surgical Management
CHAPTER 35:
Management of Fungal Periprosthetic Joint Infections
Current Evidence
Types of Fungi
Antifungal Drugs
Treatment Outcome of Fungal Periprosthetic Joint Infections (Table 35.1)
Controversies
Newer Antifungal Agents
Antifungal Cement Spacer
CHAPTER 36:
Management of Mycobacterial Infection
Current Evidence
Pathogenic Species
Diagnosis
Antimicrobial Therapy
Surgical Management
Controversies
CHAPTER 37:
Management of Prosthetic Joint Infection Caused by Enterococcus
Current Evidence
Controversies
CHAPTER 38:
Irrigation and Debridement with Modular Component Exchange for Periprosthetic Joint Infection
Current Evidence
Historical Perspective
Outcomes in Periprosthetic Hip and Knee Infection
Importance of Microorganisms
Importance of Timing of Infection and Acuity of Symptoms
Importance of Host
Controversies
CHAPTER 39:
One-Stage Exchange Arthroplasty for Periprosthetic Joint Infection
Current Evidence
Historical Perspective
Indications
Cost Effectiveness and Quality of Life
One-Stage Total Hip Arthroplasty Outcomes
One-Stage Total Knee Arthroplasty Outcomes
Controversies
CHAPTER 40:
Resection Arthroplasty
Current Evidence
Definition
Indications
Contraindications
Surgical Principles and Intraoperative Strategies
Outcomes
Controversies
CHAPTER 41:
Removal of Well-Fixed Hip and Knee Arthroplasty Components in the Setting of Periprosthetic Joint Infection
Preoperative Planning
Surgical Exposure
Removal of Hip Arthroplasty Components
Removal of Knee Arthroplasty Components
Summary
CHAPTER 42:
Two-Stage Exchange Arthroplasty: Antibiotic Spacers
Introduction
Current Evidence
Surgical Technique
Controversies
Types of Spacers
Outcomes after Spacers
Conclusion
CHAPTER 43:
Reimplantation Following Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection
Current Evidence
How do You Know periprosthetic joint infection (PJI) is Eradicated?
Intraoperative Measures
Holding Versus giving Antibiotics
What to do with postoperative positive Cultures?
Suppressive Antibiotics
Length
Role for Dual Suppression
CHAPTER 44:
Suppression of Prosthetic Joint Infection Using Antimicrobial Therapy
Current Evidence
Controversies
CHAPTER 45:
Prognostic Classification for Periprosthetic Joint Infection
Current Evidence
Introduction
Host Factors
Surgical Factors
Microorganism Factors
Prognostic Classification
CHAPTER 46:
Outcome in Periprosthetic Joint Infection Treatment
Current Evidence
Success and Failure in Periprosthetic Joint Infection Treatment
Results in Terms of Infection Control
Results in Terms of Functional Outcomes
Results in Terms of Patients’ Satisfaction
Results in Terms of Complications
Economic Impact of PJI and the Impact on Global Health Status
INDEX
TOC
Index
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