Septic Arthritis (Prosthetic Joint)
Septic Arthritis: Prosthetic Joint Infection (PJI)
Bottom Line
- All patients with PJIs should undergo culture via joint aspiration, joint debridement and/or prosthesis removal.
- Treatment of PJIs requires both surgical and antibiotic therapy.
- Retention of prosthesis and debridement may be appropriate in the setting of early PJIs (< 1 month after surgery or < 3 weeks of symptoms after surgery).
- Delayed and late onset infections often require replacement arthroplasty, with a two-stage procedure yielding the greatest success rates.
Empiric Therapy
Treatment based on timing of infection
Early (< 3months after surgery)
- Acquired during implantation (virulent organisms – S. aureus): Cefazolin OR Cloxacillin ± Rifampin
Delayed (3-12 months after surgery)
- Acquired during implantation (less virulent organisms: Coagulase negative staphylococci (CoNS) or Streptococci): Vancomycin
Late (> 12months after surgery)
- Hematogenous spread not acquired during implantation (S. aureus, beta hemolytic streptococci, and Enterobacteriaceae): Cefazolin