Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791881.003.0007
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant
This chapter discusses specific microbiology issues relating to prosthetic joint infection (PJI) and includes discussion on antibiotic prophylaxis (including elective joint replacement in the uninfected case), choice of ‘prophylaxis/treatment’ in the infected, or presumed, infected case, a suggested framework for a safe practice, antibiotic use in PJI in the age of resistance, background on rising antibiotic resistance, approach to one- and two-stage surgical management, outpatient antibiotic therapy and when to use it, monitoring/stopping rules, the particular problems of Pseudomonas and Candida in PJI, and myths and facts about what ‘immunosuppression’ actually means in practice (including MRSA), and a conclusion.
{"title":"Specific microbiology issues relating to prosthetic joint infection","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant","doi":"10.1093/MED/9780198791881.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780198791881.003.0007","url":null,"abstract":"This chapter discusses specific microbiology issues relating to prosthetic joint infection (PJI) and includes discussion on antibiotic prophylaxis (including elective joint replacement in the uninfected case), choice of ‘prophylaxis/treatment’ in the infected, or presumed, infected case, a suggested framework for a safe practice, antibiotic use in PJI in the age of resistance, background on rising antibiotic resistance, approach to one- and two-stage surgical management, outpatient antibiotic therapy and when to use it, monitoring/stopping rules, the particular problems of Pseudomonas and Candida in PJI, and myths and facts about what ‘immunosuppression’ actually means in practice (including MRSA), and a conclusion.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129764959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791881.003.0002
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant
This chapter discusses assessing the risk of prosthetic joint infection (PJI) and includes discussion on high-risk patients (classified by age, skin colour, extracellular matrix, cellular turnover, diabetes, obesity, rheumatoid arthritis, previous periarticular fractures and skin disorders). The aim is to allow the practitioner to identify high-risk patient attributes that can be positively influenced such that the risk of PJI is reduced. There are some patients with more than one risk factor and, as such, every effort must be made to reduce each even if there is a marginal gain in each. Delaying elective surgery until the risks of PJI are reduced must be encouraged but must be balanced with alleviating patient symptoms.
{"title":"Assessing risk of prosthetic joint infection","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant","doi":"10.1093/MED/9780198791881.003.0002","DOIUrl":"https://doi.org/10.1093/MED/9780198791881.003.0002","url":null,"abstract":"This chapter discusses assessing the risk of prosthetic joint infection (PJI) and includes discussion on high-risk patients (classified by age, skin colour, extracellular matrix, cellular turnover, diabetes, obesity, rheumatoid arthritis, previous periarticular fractures and skin disorders). The aim is to allow the practitioner to identify high-risk patient attributes that can be positively influenced such that the risk of PJI is reduced. There are some patients with more than one risk factor and, as such, every effort must be made to reduce each even if there is a marginal gain in each. Delaying elective surgery until the risks of PJI are reduced must be encouraged but must be balanced with alleviating patient symptoms.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"15 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132624467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791881.003.0008
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant
This chapter discusses revision arthroplasty networks and includes discussion on the proposed model for revision networks, the proposed operating framework, and aims of the revision network. The risks of prosthetic joint infection are known to be higher when undertaking revisional arthroplasty. To reduce these risks the correct decisions must be made during the lead-up to the revisional surgery. The aim is to encourage centres to set up networks to allow discussion of all revisional cases in this forum. The result should be that all patients benefit from best practice.
{"title":"Revision arthroplasty networks","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant","doi":"10.1093/MED/9780198791881.003.0008","DOIUrl":"https://doi.org/10.1093/MED/9780198791881.003.0008","url":null,"abstract":"This chapter discusses revision arthroplasty networks and includes discussion on the proposed model for revision networks, the proposed operating framework, and aims of the revision network. The risks of prosthetic joint infection are known to be higher when undertaking revisional arthroplasty. To reduce these risks the correct decisions must be made during the lead-up to the revisional surgery. The aim is to encourage centres to set up networks to allow discussion of all revisional cases in this forum. The result should be that all patients benefit from best practice.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"63 9‐10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120855284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/med/9780198791881.003.0005
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant
This chapter discusses consideration of safe patient pathways. It includes discussion on skin necrosis, safe raising of fasciocutaneous flaps around the joints, tips and tricks to avoid iatrogenic skin necrosis, prosthetic joint infection negative-pressure dressings to reduce risk, and pathways for skin necrosis. The aim is to improve the safety and viability of the access incisions with the intention of enhancing primary healing of those incisions. This advice on tissue handling must be in addition to the holistic assessment of the patient as a ‘host’ for the arthroplasty implant.
{"title":"Considering safe patient pathways","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant","doi":"10.1093/med/9780198791881.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198791881.003.0005","url":null,"abstract":"This chapter discusses consideration of safe patient pathways. It includes discussion on skin necrosis, safe raising of fasciocutaneous flaps around the joints, tips and tricks to avoid iatrogenic skin necrosis, prosthetic joint infection negative-pressure dressings to reduce risk, and pathways for skin necrosis. The aim is to improve the safety and viability of the access incisions with the intention of enhancing primary healing of those incisions. This advice on tissue handling must be in addition to the holistic assessment of the patient as a ‘host’ for the arthroplasty implant.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129840549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/med/9780198791881.003.0003
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, Vanya Gant
This chapter discusses preoperative assessment and includes discussion on assessing risk factors for prosthetic joint replacement, vascular issues for major joint replacement, what risk assessment for vascular complications should include, acute limb ischaemia, vascular injury, general cardiovascular considerations, pressure area ulceration, and amputation and rehabilitation. The importance of this aspect of patient care cannot be overstated. Pre-incision improvement in patient physiology to improve the chances of primary wound healing will reduce the chances of prosthetic joint infection.
{"title":"Preoperative assessment","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, Vanya Gant","doi":"10.1093/med/9780198791881.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780198791881.003.0003","url":null,"abstract":"This chapter discusses preoperative assessment and includes discussion on assessing risk factors for prosthetic joint replacement, vascular issues for major joint replacement, what risk assessment for vascular complications should include, acute limb ischaemia, vascular injury, general cardiovascular considerations, pressure area ulceration, and amputation and rehabilitation. The importance of this aspect of patient care cannot be overstated. Pre-incision improvement in patient physiology to improve the chances of primary wound healing will reduce the chances of prosthetic joint infection.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124049773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/MED/9780198791881.003.0004
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant
This chapter discusses thromboprophylaxis and haematomas within periprosthetic joint infection. The issue of venous thromboembolism is important for all surgical patients and, as such, those undergoing arthroplasty must undergo a careful and accurate risk assessment. Prolonged surgery and delayed postoperative mobilization are risk factors and are common to most major joint arthroplasty. Use of prophylactic agents to prevent thrombosis must be balanced with the avoidance of haematoma formation as the latter contributes to a risk of prosthetic joint infection. Should deep vein thrombosis occur then swift methods of diagnosis and treatment must be in place.
{"title":"Thromboprophylaxis and haematomas","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant","doi":"10.1093/MED/9780198791881.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780198791881.003.0004","url":null,"abstract":"This chapter discusses thromboprophylaxis and haematomas within periprosthetic joint infection. The issue of venous thromboembolism is important for all surgical patients and, as such, those undergoing arthroplasty must undergo a careful and accurate risk assessment. Prolonged surgery and delayed postoperative mobilization are risk factors and are common to most major joint arthroplasty. Use of prophylactic agents to prevent thrombosis must be balanced with the avoidance of haematoma formation as the latter contributes to a risk of prosthetic joint infection. Should deep vein thrombosis occur then swift methods of diagnosis and treatment must be in place.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121483941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1093/med/9780198791881.003.0006
Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant
This chapter discusses pathways for established prosthetic joint infection (PJI) and includes discussion on management of acute infection, surgical management of acute infection (including arthroscopic debridement and implant retention strategies), formal revision surgery, and management of chronic low-grade infection (including management of low-grade infection, antibiotic suppression, and free flaps). The main emphasis of this chapter is to guide the team on what are safe and accepted treatments for patients with confirmed PJI. The most important decision is whether the underlying implant should be retained or replaced. The latter can be in a single or multiple stages.
{"title":"Pathways for established prosthetic joint infection","authors":"Umraz Khan, G. Perks, R. Morgan-Jones, P. James, Colin Esler, V. Smyth, V. Gant","doi":"10.1093/med/9780198791881.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780198791881.003.0006","url":null,"abstract":"This chapter discusses pathways for established prosthetic joint infection (PJI) and includes discussion on management of acute infection, surgical management of acute infection (including arthroscopic debridement and implant retention strategies), formal revision surgery, and management of chronic low-grade infection (including management of low-grade infection, antibiotic suppression, and free flaps). The main emphasis of this chapter is to guide the team on what are safe and accepted treatments for patients with confirmed PJI. The most important decision is whether the underlying implant should be retained or replaced. The latter can be in a single or multiple stages.","PeriodicalId":315543,"journal":{"name":"Pathways in Prosthetic Joint Infection","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114220420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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