infections after hip or knee prosthesis.
Infection of the hip prosthesis can also take place if the dog develops an infection elsewhere in the body.
[Infection of a hip prosthesis after dry needling]. - IDN
13. Kelm J, Anagnostakos K, Schmitt E. Closed subfascial V.A.C.-therapy in periprosthetic hip infections. 2004;129(Suppl 1):S49-52
14. Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. 2002;404:116-24
Actinomyces gerencseriae hip prosthesis infection: A …
15. Lazzarini L, Manfrin V, De Lalla F. Candidal prosthetic hip infection in a patient with previous candidal septic arthritis. 2004;19:248-52
Tsukayama et al. proposed a 4-stage system consisting of early postoperative-, late chronic-, and acute hematogenous infections, and positive intraoperative cultures of specimens obtained during revision of a presumed aseptically loose total hip prosthesis .
Classification of hip joint infections
Based on the afore mentioned data, McPherson et al. developed a staging system for periprosthetic hip infections taking into consideration the acuteness of the infection, the overall medical and immune health status of the patient, and the local wound condition (Table ) . The classification of each infection may assist the surgeon identify the severity of each infection case and choose an appropriate treatment option. The system has been used in clinical practise especially in the United States and the United Kingdom [, ].
17. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection. Outcomes using a staging system. 2002;403:8-15
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Depending on the causative pathogen organism, infections can be divided into bacterial and fungal ones. Bacterial infections can be further classified as gram-positive or -negative and mono- or multibacterial. This differentiation helps the surgeon especially in making the appropriate choice for the treatment procedure. Ure at al. emphasized that a direct exchange arthroplasty can only be carried out in early infections, and if the infecting organism is of low virulence (no methicillin-resistant or gram-negative bacteria) . Moreover, the resistance profile of the causative bacterium might be associated with prolonged and complicated treatment courses. Kilgus et al. evaluated periprosthetic hip joint infections caused by antibiotic-sensitive and -resistant bacteria . The authors concluded that hip replacements infected with antibiotic-sensitive bacteria were treated successfully in 81 % of the cases, whereas arthroplasties infected with resistant bacteria were treated successfully in only 48 % of the cases.
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After radical debridement, removal of all components and taking at least five tissue samples for bacteriologic and histologic assessments, the acetabular component is cemented loosely and femoral fixation is achieved by means of a press-fit or late proximal cementation so that both are removed easily at the second stage without damaging bone stock. Postoperatively, the patient is allowed to mobilise partial weight-bearing with crutches and is discharged home when deemed safe. Antibiotic therapy tailored to the sensitivities of intraoperative cultures is continued for 4 to 6 weeks. The decision to proceed with insertion of a new prosthesis is determined if the culture of a hip aspirate performed 4 weeks after discontinuation of antibiotics is negative and inflammatory markers suggest resolution of infection (ESR ]. After the reimplantation procedure, patients are followed clinically and with ESR and CRP levels for any signs of recurring infection. Systemic antibiotics are discontinued. However, if at the second stage there is clinical evidence of ongoing infection, a repeat debridement procedure is performed with new culture specimens sent for microbiology and systemic antibiotics are adjusted accordingly. At this stage, either a repeat PROSTALAC insertion or a salvage procedure is considered after discussion of treatment options with the patient.
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28. Gundtoft PH, Overgaard S, Schønheyder HC, Møller JK, Kjærsgaard-Andersen P, Pedersen AB. The “true” incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties. A prospective cohort study. 2015;86:326-334
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24. Buller LT, Sabry FY, Easton RW, Klika AK, Barsoum WK. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. 2012;27:857-864
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