Consensus document on prosthetic joint infections

Open Access-This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. Since the start of the modern era of prosthetic surgery, pros-thetic joint infections (PJIs) have been a predominant and most feared complication. Reduction of PJI has been described as a success story, with the infection rate declining from 10% at the beginning of the 1970s to around 1% a couple of decades later (Lidgren 2001, SHPR 2011, SKAR 2013). Concerns are, however, being raised because the Scandi-navian arthroplasty registers are now reporting an increase in revision rates due to infection (Dale et al. 2012, SHPR 2011, SKAR 2013). This has caused the Swedish Orthopae-dic Society, in association with the patient insurance organization LÖF, to take action in a national program covering all clinics with the aim of cutting down PJI by half (http:// www.patientforsakring.se/PRISS.html). Prior to a one-day visit by a well-prepared interdisciplinary team, a unit would answer standard questions about its routines regarding important aspects of prophylactic measures. A report on courses of action to be taken had to be delivered by each unit within 6 months—based on critical comments from the visiting group. The effects of the project are now being evaluated. Globally, there is great variation in how PJIs are prevented and managed. Some of the preventive routines used are supported by good evidence from well-conducted studies, but there is limited information on how well the routines are adhered to in daily practice. In a recent study from the ISOC Group, covering 17 leading hospitals together performing more than 50,000 joint implants a year, there were clear discrepancies between the available evidence on the one hand and what was regarded by the participating hospitals to be important for prevention of PJI on the other (Ricciardi et al. 2013). Under the leadership of Dr Javad Parvizi of the Rothman Institute in Philadelphia and Dr Thorsten Gehrke of the ENDO Clinic in Germany, it was decided to start working groups to collect information on prevention and treatment of PJI, prior to a 2-day international consensus meeting in Philadelphia at the end of July 2013. Fifteen groups covered topics that ranged from comorbidities, skin preparation, perioperative antibiotics, and operative environment to the diagnosis of PJI, antibiotic treatment, one-change vs. two-stage exchange arthroplasty, and prevention of late prosthetic infections. The …