Overview
Management of prosthetic joint infections (PJI) is a challenging task. These infections include different clinical and microbiological settings calling upon various treatment strategies according to infection type (acute or chronic), bone quality, the involved micro-organism and the patient's general condition and willing.
Treatment of PJI combines surgery and prolonged antibiotic therapy. In some patients with a high operative risk prolonged suppressive antibiotic therapy can be used.
Lack of large prospective studies motivated the conception of this cohort with a long term follow up, regardless to PJI management procedures.
Description
Large prospective cohort study in a French referral center for bone and joint infections.
Population
- all patients who consented to participate in the study with PJI treated with:
- debridement-synovectomy for acute infection
- with one-stage, two-stage exchange arthroplasty for chronic infection
- other procedures (complete removal of the prosthesis) and antibiotic therapy
- patients (non-operated or operated) receiving prolonged suppressive antibiotic therapy
- Outcome
- Follow-up at least 2 years
- Events monitored: reinfection including relapse and new infection, joint revision for mechanical failure, PJI related or non-related death Study duration: 10 years. Recruitment period: 4 years. Maximal duration of data collection: 6 years. Investigator center: monocenter study. Mean patient inclusion per year: 100 patients per year.
Eligibility
Inclusion Criteria:
- Patient aged over 18 years old with hip, knee and or shoulder joint prosthesis who consented to participate in the study with:
- According to musculoskeletal infection society definition: PJI is present when one of the major criteria exists or four out of six minor criteria.
Major Criteria:
- Two positive periprosthetic cultures with phenotypically identical organisms, OR
- A sinus tract communicating with the joint, OR
Minor Criteria:
- Elevated serum C-reactive protein (CRP) AND erythrocyte sedimentation rate (ESR)
- Elevated synovial fluid white blood cell (WBC)
- Elevated synovial fluid polymorphonuclear neutrophil percentage (PMN%)
- The presence of pus in the joint without known cause
- Positive histological analysis of periprosthetic tissue
- A single positive culture
Or a PJI which meets the following three criteria:
- Medical story suggesting prosthetic joint infection.
- The presence of pain either with or without swelling for more than 3 months unrelated to a mechanical cause.
- Germ identification in a single sample of fluid aspiration or tissue culture.
- Or microbial growth in prosthesis sonication fluid culture greater than 50CFU/ml.
Exclusion Criteria:
- Patient who does not meet eligibility criteria.
- Patient lawfully deprived of his liberty.
- Patient not insured under social security scheme.