The diagnosis of periprosthetic infection.
Identifieur interne : 000332 ( Main/Exploration ); précédent : 000331; suivant : 000333The diagnosis of periprosthetic infection.
Auteurs : RBID : pubmed:23898349Abstract
Periprosthetic infection (PJI) is the most serious joint replacement complication, occurring in 0.8-1.9% of knee arthroplasties and 0.3-1.7% of hip arthroplasties. A definition of PJI was proposed in the November 2011 issue of the journal Clinical Orthopedics and Related Research. The presence of a fistula or of local inflammatory signs is indicative of PJI, but in many cases local pain is the only symptom. In the absence of underlying inflammatory conditions, C-reactive protein measurement is the most useful preoperative blood test for detecting infection associated with a prosthetic joint. The most useful preoperative diagnostic test is the aspiration of synovial joint fluid to obtain a total and differential cell count and culture. Intraoperative frozen sections of periprosthetic tissues produce excellent accuracy in predicting a diagnosis of PJI but only moderate accuracy in ruling out the diagnosis. In this process, obtaining a quality sample is the first step, and determines the quality of microbiological results. Specimens for culture should be obtained prior to the initiation of antibiotic treatment. Sonication of a removed implant may increase the culture yield. Plain radiography has low sensitivity and low specificity for detecting infection associated with a prosthetic joint. Computed tomography and magnetic resonance imaging may be useful in the evaluation of complex cases, but metal inserts interfere with these tests, and abnormalities may be non-specific. Labelled-leucocyte imaging (e.g., leucocytes labelled with indium-111) combined with bone marrow imaging with the use of technetium-99m-labelled sulphur colloid is considered the imaging test of choice when imaging is necessary.
DOI: 10.2174/1874325001307010178
PubMed: 23898349
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A definition of PJI was proposed in the November 2011 issue of the journal Clinical Orthopedics and Related Research. The presence of a fistula or of local inflammatory signs is indicative of PJI, but in many cases local pain is the only symptom. In the absence of underlying inflammatory conditions, C-reactive protein measurement is the most useful preoperative blood test for detecting infection associated with a prosthetic joint. The most useful preoperative diagnostic test is the aspiration of synovial joint fluid to obtain a total and differential cell count and culture. Intraoperative frozen sections of periprosthetic tissues produce excellent accuracy in predicting a diagnosis of PJI but only moderate accuracy in ruling out the diagnosis. In this process, obtaining a quality sample is the first step, and determines the quality of microbiological results. Specimens for culture should be obtained prior to the initiation of antibiotic treatment. Sonication of a removed implant may increase the culture yield. Plain radiography has low sensitivity and low specificity for detecting infection associated with a prosthetic joint. Computed tomography and magnetic resonance imaging may be useful in the evaluation of complex cases, but metal inserts interfere with these tests, and abnormalities may be non-specific. Labelled-leucocyte imaging (e.g., leucocytes labelled with indium-111) combined with bone marrow imaging with the use of technetium-99m-labelled sulphur colloid is considered the imaging test of choice when imaging is necessary.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="PubMed-not-MEDLINE"><PMID Version="1">23898349</PMID><DateCreated><Year>2013</Year><Month>07</Month><Day>30</Day></DateCreated><DateCompleted><Year>2013</Year><Month>07</Month><Day>30</Day></DateCompleted><DateRevised><Year>2013</Year><Month>08</Month><Day>02</Day></DateRevised><Article PubModel="Electronic-Print"><Journal><ISSN IssnType="Electronic">1874-3250</ISSN><JournalIssue CitedMedium="Print"><Volume>7</Volume><PubDate><Year>2013</Year></PubDate></JournalIssue><Title>The open orthopaedics journal</Title><ISOAbbreviation>Open Orthop J</ISOAbbreviation></Journal><ArticleTitle>The diagnosis of periprosthetic infection.</ArticleTitle><Pagination><MedlinePgn>178-83</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2174/1874325001307010178</ELocationID><Abstract><AbstractText>Periprosthetic infection (PJI) is the most serious joint replacement complication, occurring in 0.8-1.9% of knee arthroplasties and 0.3-1.7% of hip arthroplasties. A definition of PJI was proposed in the November 2011 issue of the journal Clinical Orthopedics and Related Research. The presence of a fistula or of local inflammatory signs is indicative of PJI, but in many cases local pain is the only symptom. In the absence of underlying inflammatory conditions, C-reactive protein measurement is the most useful preoperative blood test for detecting infection associated with a prosthetic joint. The most useful preoperative diagnostic test is the aspiration of synovial joint fluid to obtain a total and differential cell count and culture. Intraoperative frozen sections of periprosthetic tissues produce excellent accuracy in predicting a diagnosis of PJI but only moderate accuracy in ruling out the diagnosis. In this process, obtaining a quality sample is the first step, and determines the quality of microbiological results. Specimens for culture should be obtained prior to the initiation of antibiotic treatment. Sonication of a removed implant may increase the culture yield. Plain radiography has low sensitivity and low specificity for detecting infection associated with a prosthetic joint. Computed tomography and magnetic resonance imaging may be useful in the evaluation of complex cases, but metal inserts interfere with these tests, and abnormalities may be non-specific. Labelled-leucocyte imaging (e.g., leucocytes labelled with indium-111) combined with bone marrow imaging with the use of technetium-99m-labelled sulphur colloid is considered the imaging test of choice when imaging is necessary.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Del Arco</LastName><ForeName>Alfonso</ForeName><Initials>A</Initials><Affiliation>Department of Clinical Internal Medicine, Section of Infectious Diseases, Hospital Costa del Sol, University of Malaga, Spain.</Affiliation></Author><Author ValidYN="Y"><LastName>Bertrand</LastName><ForeName>María Luisa</ForeName><Initials>ML</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType>Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2013</Year><Month>06</Month><Day>14</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Open Orthop J</MedlineTA><NlmUniqueID>101480491</NlmUniqueID></MedlineJournalInfo><OtherID Source="NLM">PMC3722546</OtherID><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Diagnosis</Keyword><Keyword MajorTopicYN="N">hip</Keyword><Keyword MajorTopicYN="N">joint replacement</Keyword><Keyword MajorTopicYN="N">knee.</Keyword><Keyword MajorTopicYN="N">periprosthetic infection</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="ppublish"><Year>2013</Year><Month></Month><Day></Day></PubMedPubDate><PubMedPubDate PubStatus="received"><Year>2012</Year><Month>12</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2012</Year><Month>12</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2013</Year><Month>4</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="epublish"><Year>2013</Year><Month>6</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2013</Year><Month>7</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2013</Year><Month>7</Month><Day>31</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2013</Year><Month>7</Month><Day>31</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="doi">10.2174/1874325001307010178</ArticleId><ArticleId IdType="pii">TOORTHJ-7-178</ArticleId><ArticleId IdType="pubmed">23898349</ArticleId><ArticleId IdType="pmc">PMC3722546</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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