JOINT ARTHROPLASTY INFECTIONS: SALVAGE OR EXPLANT?

摘要

- Arthroplasty infections in dogs are typically managed by explanting the devices; treatment algorithms in humans are much more refined, and some cases may be successfully addressed with prosthesis retentionRecognizing and confirming early infection can be challenging, as radiographic changes are not always present, and cultures of joint fluid often fail to identify the pathogenOpen debridement with prosthesis retention can be successful if the duration of clinical signs is short, the organism is not multi-drug resistant, and the prosthesis is stable.Infection is regarded as the most devastating complication of total joint arthroplasty, in both dogs and humans. While the risk of infection is thankfully low, the frequency of infection may be increasing, as total joint arthroplasty in dogs gains further popularity. Wider use of these procedures is likely the result of the improved reliability of total hip arthroplasties, and commercial release of resurfacing systems for the elbow and stifle. Infected implants pose several clinical challenges related to both diagnosis and treatment. Whereas fracture fixation devices can be removed once a fracture has healed, joint replacements must ideally remain functional for the lifetime of the patient, and explanting may result in a very poor outcome. Guidelines for managing arthroplasty infections in dogs is sparse, and can be succinctly summarized in one sentence: explant is recommended as other strategies typically fail. Treatment algorithms for arthroplasty infections in humans are much more refined, and some cases may be successfully addressed with prosthesis retention. The purpose of this lecture is to discuss the management of total joint arthroplasty infection in dogs.