2023 ISAKOS Biennial Congress ePoster
An Australian Algorithm to Guide the Surgical Management of Chronic Prosthetic Joint Infection: A Multi-Disciplinary Team Approach
Christopher J. Wilson, A/Prof, MBChB, MRCS, FRACS, PhD, Adelaide, SA AUSTRALIA
Melinda Jiang, BClinSci/MD student, Norwood, SA AUSTRALIA
James Sires, MD, Adelaide, SA AUSTRALIA
Santhosh Daniel, MD, Bedford Park, South Australia AUSTRALIA
Flinders Medical Cente, Flinders University, Adelaide, South Australia, AUSTRALIA
FDA Status Not Applicable
Summary
We aim to review contemporary concepts in the surgical management of Periprosthetic Joint Infection (PJI) and develop an evidence-based algorithm to optimise the management of chronic hip and knee PJI, incorporating a multidisciplinary team (MDT) approach.
ePosters will be available shortly before Congress
Abstract
Chronic prosthetic joint infection (PJI) is a leading cause of failure for total joint arthroplasty. Historically, two-stage revision arthroplasty has been considered the gold standard approach to chronic PJI, however emerging evidence suggests one-stage revision arthroplasty may be underutilised. To our knowledge, there have been no previously published guidelines for the surgical management of chronic PJI in Australia, resulting in significant heterogeneity in management within and across centres.
We aim to review contemporary concepts in the surgical management of PJI and develop an evidence-based algorithm to optimise the management of chronic hip and knee PJI, incorporating a multidisciplinary team (MDT) approach.
A review was conducted to identify existing articles discussing surgical management of chronic PJI, specifically contraindications to one-stage revision arthroplasty. Absolute contraindications for one-stage revision include difficult to treat organisms, significant soft tissue compromise and concurrent sepsis. Relative contraindications include lack of pre-operative identification of organism, presence of a sinus tract, fungal infections, significant bone loss, and immunocompromise. In determining management for patients with a relative contraindication, MDT discussion with consideration of the patient’s overall local, host and microbiological profile is necessary.
Using gathered evidence, absolute and relative contraindications for one-stage revision arthroplasty were developed into an algorithm. The algorithm is designed to assist our PJI MDT in making optimised decisions when choosing between a one-stage versus two-stage approach. Ongoing follow-up is underway to determine the effect of implementing this algorithm on patient outcomes, eradication rates and revision rates within our centre.