Navigation Links
New IDSA guidelines aim to reduce death, disability, and cost of prosthetic joint infections
Date:12/6/2012

[EMBARGOED FOR DEC. 7, 2012, ARLINGTON, Va.] Of the one million people each year who get hips and knees replaced, as many as 20,000 will get an infection in the new joint, a number that is expected to skyrocket in the next 20 years. Multispecialty physician teams need to work together to reduce disability, death and costs associated with the ever-growing number of these prosthetic joint infections, note the first guidelines on the topic being released by the Infectious Diseases Society of America (IDSA).

"There are very few things that improve quality of life as much as joint replacement, but 1 to 2 percent of the time the new joint can become infected, even when precautions are taken," said Douglas R. Osmon, MD, associate professor of medicine in the division of infectious diseases at Mayo Clinic, Rochester, Minn. "There are many different ways to treat these infections to achieve the same outcome. The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient."

Hips, knees and other joint replacements such as shoulders and elbows can become infected during the surgery or months or even years later.

The guidelines, which are being published online today in the journal Clinical Infectious Diseases, outline the evidence and opinions regarding methods that are appropriate to diagnose the infections early and treat them most effectively, according to patients' specific situations. Most infections require long courses of antibiotics and surgery, which can range from washing out the infected area to removal and replacement of the joint to permanent removal of the prosthesis to amputation.

Multidisciplinary teams should include an orthopedist and an infectious diseases specialist, as well as other specialists on a case-by-case basis. For instance, if the patient is older and has heart disease, an internist should be involved, and if the surgical wound is difficult to close, a plastic surgeon should be consulted, said Dr. Osmon. In rural areas with few specialists, doctors should consider consulting with infectious diseases specialists or orthopedists at referral centers.

The guidelines describe the best methods for diagnosis of prosthetic joint infections. These infections can be difficult to diagnose, and not all are obvious, notes Dr. Osmon. Also, problems with joint replacements particularly loosening of the prosthesis and pain may be caused by infection or by problems in the materials in the device itself.

Among the recommendations in the guidelines:

  • Physicians should suspect a prosthetic joint infection in a patient who has any of the following: persistent wound drainage in the skin over the joint replacement; sudden onset of a painful prosthesis, or ongoing pain after the prosthesis has been implanted, especially if there had been no pain for several years or if there is a history of prior wound healing problems or infections.

  • In patients with prosthetic joint infections:

    o Those with a well-fixed prosthesis without an open wound to the skin who had surgery less than 30 days previously are likely candidates for debridement, which means re-opening the incision and cleaning out the wound.

    o Those who have more extensive infection that has affected the bone and tissue may need to have the prosthesis replaced, either in the same surgery in which the prosthesis is removed, or in a later surgery.

    o Patients who cannot walk and who have limited bone stock, poor soft tissue coverage and infections due to highly resistant organisms may need to have the implants permanently removed. In some cases the joint may need to be fused.

    o Amputation of the limb may be necessary, but only as a last resort. Prior to amputation, the patient should be referred to a center with specialist experience in prosthetic joint infections, if his or her condition allows.

  • Four to six weeks of intravenous or highly bioavailable oral antibiotic therapy is almost always necessary to treat prosthetic joint infections.

"The number of people suffering from prosthetic joint infections will continue to grow because, although we are getting better at preventing infection, that is countered by the increase in older and sicker people having joint replacement," said Dr. Osmon.

The nine-member prosthetic joint infections guidelines panel comprises experts from the United States and Europe representing the infectious diseases and orthopedic specialties. In addition to Dr. Osmon, the panel includes: Elie F. Berbari, Anthony R. Berendt, Daniel Lew, Werner Zimmerli, James M. Steckelberg, Nalini Rao, Arlen Hanssen and Walter R. Wilson.


'/>"/>

Contact: Jerica Pitts
jpitts@pcipr.com
312-558-1770
Infectious Diseases Society of America
Source:Eurekalert

Related medicine news :

1. New Guidelines Urge Limiting Endoscopy for GERD
2. More Cancers May Be Missed Under Latest Mammogram Guidelines
3. Guidelines Issued to Resolve Temporary Facial Paralysis
4. First comprehensive guidelines for managing anaplastic thyroid cancer published in Thyroid journal
5. UMSOM dean urges caution in revising diagnostic guidelines for gestational diabetes
6. Guidelines developed for extremely premature infants at NCH proven to be life-changing
7. New pediatric heart failure guidelines a first in Canada
8. Modeling Good Research Practices guidelines for modeling in health care research available now
9. U-M guidelines help family physicians evaluate, manage urinary incontinence for women
10. New clinical guidelines for managing hypothyroid disease presented in Thyroid Journal
11. New Strep Throat Guidelines Tackle Antibiotic Resistance
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:1/20/2017)... ... 20, 2017 , ... “Code Word: Chocolate Biscuit”: a biographical account following a man who went ... creation of published author, Marlyn Ivey, born in Lynn Haven, Florida and at the age ... at 19 years of age, he joined the Navy and got married right out of ...
(Date:1/20/2017)... ... January 20, 2017 , ... “Knowledge is God’s Lighthouse”: ... by faith. “Knowledge is God’s Lighthouse” is the creation of published author, Gene Gaapf, ... and poetry collections. , “I have been writing since high school and have ...
(Date:1/19/2017)... ... , ... Next week after January 20th, the fear for many is that ... health needs of over 30 million. Many interviews with Dr. Carol Francis at the ... servants were suppose to prioritize. Interviews provided below. , Among those present ...
(Date:1/19/2017)... ... 2017 , ... WhoHaha , a digital media company dedicated to creating ... to produce a three-part video series that uses humor to highlight ways to improve ... of AHA’s Healthy For Good™ movement, which is designed to inspire all Americans to ...
(Date:1/19/2017)... Scotch Plains, NJ (PRWEB) , ... January 19, ... ... a board certified dermatologist by the American Board of Dermatology and fellowship trained ... Institute of the National Institutes of Health, Dr. Li completed his internship in ...
Breaking Medicine News(10 mins):
(Date:1/20/2017)... , Jan. 20, 2017  Ethicon ... acquired Megadyne Medical Products, Inc., a privately ... and markets electrosurgical tools used in operating ... intelligence of Ethicon,s* advanced energy devices with ... a major step forward in Ethicon,s goal ...
(Date:1/20/2017)... , Jan. 20, 2017  Palladian Health, a ... announced the launch of an opioid management program ... on opioids and helps stem the growing tide ... prescribed to treat chronic non-cancer pain (back pain, ... risks and lack of evidence regarding long-term effectiveness. ...
(Date:1/20/2017)... , January 20, 2017 Avillion LLP, ... appointment of Mark Weinberg , MD MBA as Chief Medical ... , USA . ... Dr Weinberg has spent more than 17 years ... 20" pharma companies to micro-cap biotech. Over the course of his ...
Breaking Medicine Technology: