Checklist of criteria for successful salvage of
infected joint prosthesis
- No instability or loosening of the prosthesis
(clinically or on X-ray)
- Good quality of soft tissues with no sinus
formation
- Not immunosuppressed
- Not presenting with septic shock
- Short duration of symptoms before presentation
- < 3 days if acute hematogenous presentation in
longstanding joint
- < 2 weeks if occurring in the setting of a recently
implanted joint
- Patient fully informed and accepting of the harms
and benefits of this approach
- Versus higher likelihood of treatment success with
2 stage procedure
- If organism = MRSA or MRSE, then it's sensitive to
both rifampicin and fusidic acid
- Open debridement with synovectomy and polyethylene
exchange better than arthroscopic washout and debridement
- Some organisms do better than others (Streptococcus
> S. aureus or Gram negative > MRSA > 2 organisms > fungal [which
needs 2 stage])
(Adapted from the Australian Therapeutic Guidelines:
Antibiotic)