The role of the primary care physician in early diagnosis of periprosthetic joint infection
1 Department of Adult Orthopaedics, Orthopaedic Clinic, Centre of Postgraduate Medical Education, Prof. Adam Gruca Teaching Hospital in Otwock, Otwock, Poland
2 Orthopaedic Clinic, Centre of Postgraduate Medical Education, Prof. Adam Gruca Teaching Hospital in Otwock, Otwock, Poland
Correspondence: Secretary’s office of the Orthopaedic Clinic, Centre of Postgraduate Medical Education, Konarskiego 13, 05-400 Otwock, Poland, e-mail: klin_ortop.a.grucy@wp.pl
Pediatr Med Rodz 2017, 13 (4), p. 460–469
DOI: 10.15557/PiMR.2017.0049
ABSTRACT

Hip and knee replacement is a common procedure in the treatment of advanced arthropathy. It relieves pain and restores joint function. That is why the number of arthroplasties is continuously increasing. In view of the growing number of patients with endoprostheses, shorter hospitalisation after the surgery, problems with availability of specialists and an increasing role of primary care physicians, family doctors need better knowledge of the most severe postoperative complication, i.e. periprosthetic joint infection. The diagnosis of chronic periprosthetic infection is a complex and challenging problem. The symptoms of early postoperative infection or acute haematogenous periprosthetic infection should be diagnosed as soon as possible as proper treatment preconditions full recovery with implant preservation. Delayed diagnosis and failure to apply early surgical intervention change the treatment algorithm and which frequently entail prolonged multi-stage treatment. If early periprosthetic joint infection is suspected, the best decision is to urgently refer the patient again to the hospital where the surgery was performed. In this case, antibiotic therapy is vital; however, if it is instituted without proper indications, it cannot warrant recovery and blurs the picture of the disease. Before antibiotics are administered, an attempt at confirming the inflammation should be made and the responsible pathogen isolated so that targeted antibiotic therapy can be implemented. Early antibiotic administration makes it much harder to isolate the pathogen responsible and increases the number of multidrug resistant strains. The treatment of periprosthetic joint infection is always based on surgery combined with targeted antibiotic therapy. Prompt diagnosis and proper surgical management offer chances for the patient’s recovery and normal functioning. Orthopaedic surgical procedures are usually scheduled. Proper patient preparation, consisting in the stabilisation of systemic diseases, their proper control and elimination of systemic inflammatory foci, is crucial in the prevention of periprosthetic joint infection.

Keywords: periprosthetic joint infection, diagnosis, antibiotic therapy, postoperative management, primary care physician