The combination of serology and the aspiration can help the clinician confirm or refute diagnosis of PJI. In the presence of normal level of these tests, infection is “unlikely,” however, abnormal levels of either test should prompt further investigation in the form of joint aspiration. 17īased on guidelines by the American Academy of Orthopaedic Surgeons (AAOS), workup for diagnosis of PJI starts with ordering ESR and CRP due to their high sensitivity and acceptable specificity. In a study by Marculescu and Cantey, 19% of PJI episodes were polymicrobial. A considerable proportion of PJIs can be polymicrobial. 4, 13 On occasions, Gram-negative bacteria 14, 15 and fungi 16 may also result in PJI. 12Ī majority of PJI's are caused by Gram-positive cocci ( Staphylococcus aureus and coagulase-negative Staphylococcus). These strains have mutations that impair the electron transport pathway. “Small colony variant” strains are particularly skilled in invading and living inside the host cells. 10, 11 According to this concept, staphylococci can invade and live inside the host cells, facilitating long term persistence of the microorganism in bone via evasion of antibiotics and immune system responses. 10Įvidence suggested intracellular internalization of staphylococci as a mechanism contributing to pathogenesis of PJI and resistance to treatment. 8, 9 Attachment of bacteria to a surface involves cell-to-cell adhesion between microorganisms and the artificial surface. 7 Biofilm is a complex structure comprised of microorganisms enveloped in macromolecules of glycocalyx and other protective structures. 6īiofilms play an important role in pathogenesis of PJI. In contrast, irreversible adhesion depends on more specific structures and receptors. Biomaterial and surrounding joint fluid also play a role in reversible adhesion of the bacteria to the implant. 6 The reversible attachment works based on nonspecific physical and chemical characteristics of the bacteria. 6 Two distinguishable phases of reversible (non-specific) and irreversible (specific) attachments occur during bacterial adhesion to the surface of the implant. Pathophysiology of periprosthetic joint infectionĪdherence of bacteria to the implant is the first step in pathogenesis of PJI. ![]() hospitals increased from $320 million in 2001 to $566 million in 2009, and it is estimated that the cost will exceed $1.62 billion by 2020. The annual cost of infected revisions to U.S. 4, 5 In spite of the relatively low incidence of PJI, the financial burden remains enormous. 3 However, single institution studies using more precise definitions for PJI, reported lower rates ranging from about 0.6% to 0.9%. found the relative incidence ranged between 2.0% and 2.4% of total hip arthroplasties (THA) and total knee arthroplasties (TKA). Using the nation-wide in-patient sample (NIS) data, Kurtz et al. ![]() 1, 2 Periprosthetic joint infection (PJI), one of the major complications and etiologies of implant failure after TJA, is associated with substantial financial burden on the healthcare system and significant physical and psychological morbidity on patients. Given the increase of total joint arthroplasty (TJA) being performed annually, the number of complications necessitating revision surgery is increasing. DAIR - Debridement, Antibiotics and Implant Retention. MHRA 'DAIR - Debridement, Antibiotics and Implant Retention', All Acronyms,, Bluebook All Acronyms, DAIR - Debridement, Antibiotics and Implant Retention (May. "DAIR - Debridement, Antibiotics and Implant Retention". DAIR - Debridement, Antibiotics and Implant Retention, All Acronyms, viewed May 30, 2023, MLA All Acronyms. Retrieved May 30, 2023, from Chicago All Acronyms. Please use the following to spread the word:ĪPA All Acronyms.
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