Prosthetic Joint Infection

Javier Cobo; Jose Luis Del Pozo


Expert Rev Anti Infect Ther. 2011;9(9):787-802. 

In This Article

Clinical Presentation

On the basis of clinical presentation, infections associated with prosthetic joints can be classified as: positive intraoperative culture, early postoperative infection, acute hematogenous and late chronic (Figure 1 & Box 1, Box 2, Box 3).[22]

Approximately 50% of PJIs are late chronic infections, 35% early postoperative, 10% acute hematogenous and the remaining 5% are positive intraoperative cultures.[23] The most frequent symptom overall is pain,[24] frequently exacerbated by motion. Local warmth, tenderness, drainage and effusion may be also present. In cases of early infection, the patient typically presents with local and systemic signs and symptoms. These infections are mainly caused by virulent microorganisms such as S. aureus or Gram-negative bacilli. Late chronic infection is characterized by subtle signs and symptoms, sometimes not suggestive for infection (e.g., persistent pain) and accompanied by loosening of the prosthesis at the bone–cement interface, and sometimes by sinus tract formation with chronic discharge. This may occur after previously misdiagnosed superficial infection treated by a short-term course of noncurative antibiotics. This type of infection is caused by less virulent microorganisms, such as coagulase-negative staphylococci and P. acnes. Acute local symptoms in a previously nonpainful joint are characteristic of acute hematogenous infections. The 'positive intraoperative cultures' group indicates a positive culture from samples obtained at the time of revision arthroplasthy in patients without prior suspicion of infection.[25]