الفهرس 
RISK FACTORS FOR INFECTION IN TOTAL HIP ARTHROPLASTIESOnly 14 pages are availabe for public view
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Abstract
W
ith the increasing number of total joint replacement procedures, the number of complications from that surgery has also been on the rise. Although quite rare (<1%), a PPI may ruin even the best and technically excellent joint replacement procedure, causing extensive damage and loss of bone and periprosthetic tissues, which makes subsequent restoration surgery extremely difficult.
Key risk factors for prosthetic joint infection include previous joint arthroplasty, a surgical site infection not involving the joint prosthesis, the presence of malignancy and a National Nosocomial Infection Surveillance System risk score of 1 or 2. Other suggested risk factors include advanced age, diabetes mellitus, previous native joint infection, obesity, poor nutrition, skin disease and pre-existing joint disease (particularly rheumatoid arthritis). Those undergoing revision of an existing prosthetic joint are at greater risk than those undergoing primary joint replacement. A post-operative apparently superficial surgical site infection may be indicative of deeper infection involving the implant. Haematogenous seeding of a bacteraemic infection to a prosthesis is rare (overall less than 0.5% in one series). The rate of seeding to a prosthetic joint in S. aureus bacteraemia, however, may be as high as 34%.
The correct diagnosis of a prosthetic joint infection (PJI) is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise.
Although a simple gold standard to confirm PJI is lacking, diagnostic criteria have been proposed. The presence of 1 or more of the following criteria is believed to be adequate for PJI diagnosis: acute inflammation on histopathologic examination of periprosthetic tissue, sinus tract communicating with the prosthesis, gross purulence in the joint space, or growth of the same microorganism from 2 or more cultures of joint aspirates or periprosthetic tissue.
The goal of treating infection associated with a prosthetic joint is a pain-free, functional joint. This can best be achieved by eradication of the infection. Various therapies have been used, including surgical removal of all infected tissue and the implant and a combination of débridement with implant retention and long-term antimicrobial therapy that is active against biofilm microorganisms.
Better outcomes have been reported for two-stage total hip arthroplasty (THA) revision for infection. However, one-stage revision arthroplasty remains an attractive alternative option since it requires only one operation. A one-stage procedure may be as successful as a two-stage procedure provided some criteria are fulfilled.
KEY WORD : INFECTED-TOTALHIP-ARTHROPLASTRY-MANAGEMENT