Bikram Keshari KarAIIMS , India
Title: Prosthetic joint infection and its customised solution
Prosthetic joint infection (PJI) is a tremendous burden for individual patient as well as to the treating surgeon. Simultaneously it poses a huge financial threat along with significant morbidity. Periprosthetic joint infection is a serious complication occurring in 1% to 2% of primary arthroplasties and 4% of revision arthroplasties, the challenge in the management of PJI is the persistence of micro-organisms on the implant surface in the form of biofilm. Appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity.
Material and Methods
A case series of 16 patients with prosthetic joint infection, where removal of prosthesis, extensive debridement, antibiotic cement spacer insertion done and antibiotics was given as per intra-op culture and sensitivity report for 3 weeks. USG guided aspiration done after 3 weeks which was sent for Gram stain and culture sensitivity and blood Sample sent for CBC,ESR,CRP,SR. FERRITIN AND SR.PROCALCITONIN , alfa - defensin and if report came –ve then revision arthroplasty done using following options ,if bone stock adequate , done uncemented solution stem prosthesis, if proximal femur deficient then proximal femur prosthesis, and for acetabulum uncemented cup for adequate bone stock , cemented cup for inadequate bone stock and in case of widen acetabulum, done autograft with uncemented cup. In case of +ve USG guided joint aspirate then another antibiotic cement spacer kept for 3 more weeks again USG guided aspiration done after 3 weeks and revision arthroplasty done using above mentioned following options once joint aspirate -ve for above infective and inflammatory parameters. The same protocol was also applying to infected knee joint revision also.
Difficult arthroplasty requires planning and customized solution to get functional joint, taking all the factors into consideration. when the other options look gloomy this is a good method to salvage and provide functional joint to the patient.
Keywords:Prosthetic Joint Infection (PJI), Arthroplasty, Bone stock, Cemented, Uncemented, Prosthesis, Solution Stem