Infection Associated with Prosthetic Joints

Infection Associated with Prosthetic Joints

A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. Physical examination reveals a sinus tract overlying her left hip. A radiograph shows loosening of the prost...

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Bibliographic Details
Published in:The New England journal of medicine Vol. 361; no. 8; pp. 787 - 794
Main Authors: Del Pozo, Jose L, Patel, Robin
Format: Journal Article
Language:English
Published: Waltham, MA Massachusetts Medical Society 20-08-2009
Subjects:
Biological and medical sciences
General aspects
Heart attacks
Immune system
Infections
Joint surgery
Medical sciences
Microorganisms
Older people
Pain
Prostheses
Risk factors
Wound healing
Osteoarticular system
Human
Infection
Medicine
Association
Prosthesis
Joint
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Summary:A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. Physical examination reveals a sinus tract overlying her left hip. A radiograph shows loosening of the prosthesis at the bone–cement interface. How should her case be managed? A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain, 8 months after undergoing total left-hip arthroplasty. Physical examination reveals a sinus tract overlying her left hip. How should her case be managed? Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Response A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. The pain has not responded to nonsteroidal antiinflammatory drugs. Physical examination reveals a sinus tract overlying her left hip. Her leukocyte count is 8000 per cubic millimeter, and the C-reactive protein (CRP) level is 15.5 mg per liter. A radiograph shows loosening of the prosthesis at the bone–cement interface. Synovial-fluid aspirate shows 15×10 3 cells per cubic millimeter (89% neutrophils); cultures of an aspirate from the hip grow Staphylococcus epidermidis . How should . . .
ISSN:0028-4793
1533-4406
DOI:10.1056/NEJMcp0905029