Management of Orthopaedic Infections: A Practical Guide

Management of Orthopaedic Infections: A Practical Guide
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Dedication
Contents
1 Detection of Microbes in Orthopaedic Infections
	1.1 Introduction
	1.2 Culture-Based Microbiology
		1.2.1 Limitations of Culture-Based Microbiology
		1.2.2 Detection of Microbes in Biofilm
		1.2.3 Infections with Atypical Organisms
		1.2.4 Orthopaedic Hardware Infections
		1.2.5 Native Bone and Joint Infections
	1.3 Molecular Techniques
		1.3.1 Polymerase Chain Reaction (PCR)
		1.3.2 Next-Generation Sequencing (NGS)
	1.4 Conclusions
2 Antibiotics for Orthopaedic Infections
	2.1 Systemic Antibiotics
		2.1.1 Definitions
		2.1.2 Antibiotic Selection and Administration
		2.1.3 Intravenous versus Oral Antibiotics
	2.2 Antiseptics
		2.2.1 Povidone-Iodine
		2.2.2 Chlorhexidine (Gluconate/Digluconate)
	2.3 Carriers that may be Associated with Antibiotics
		2.3.1 Nondegradable
		2.3.2 Biodegradable
	2.4 Antibiotics for Use in Carriers
		2.4.1 Gentamicin/Tobramycin
		2.4.2 Vancomycin
	2.5 Topical Antibiotics
	2.6 Treatment Failure
	2.7 Collaboration between Orthopaedic Surgeons and Infectious Disease Specialists
	2.8 Conclusion
3 Irrigation Solutions for Orthopaedic Infections
	3.1 Acetic Acid
		3.1.1 Overview of Antiseptic Agents
		3.1.2 Efficacy as Surgical Wound Irrigant
	3.2 Bacitracin and Polymyxin
		3.2.1 Overview of Antiseptic Agent
		3.2.2 Efficacy as a Surgical Wound Irrigant
	3.3 Dilute Povidone-Iodine (PI)
		3.3.1 Overview of Antiseptic Agent
		3.3.2 Efficacy as a Surgical Wound Irrigant
	3.4 Chlorhexidine
		3.4.1 Overview of Antiseptic Agent
		3.4.2 Efficacy as a Surgical Wound Irrigant
	3.5 Sodium Hypochlorite (NaOCl)
		3.5.1 Overview of Antiseptic Agent
		3.5.2 Efficacy as a Surgical Wound Irrigant
	3.6 Hydrogen Peroxide
		3.6.1 Overview of Antiseptic Agent
		3.6.2 Efficacy as a Surgical Wound Irrigant
	3.7 Conclusion
4 Surgical Wound Dressings after Treating Orthopaedic Infections
	4.1 Introduction
	4.2 Characteristics of Optimal Surgical Dressings
	4.3 Dressing Types
		4.3.1 Nonocclusive and Occlusive Dressings
		4.3.2 Dressing Application Tips and Tricks
		4.3.3 Wound Vacuum Systems
	4.4 Algorithm for Surgical Dressing Selection
	4.5 Conclusion
5 Osteomyelitis
	5.1 Introduction
	5.2 Terminology
	5.3 Classification
		5.3.1 Type 1 (Medullary)
		5.3.2 Type 2 (Superficial)
		5.3.3 Type 3 (Localized)
		5.3.4 Type 4 (Diffuse)
	5.4 Diagnosis
		5.4.1 Clinical Features
		5.4.2 Laboratory Tests
		5.4.3 Imaging
		5.4.4 Microbiological Diagnosis
		5.4.5 Histological Diagnosis
	5.5 Diagnostic Criteria
	5.6 Microbiology
	5.7 Treatment of Osteomyelitis
		5.7.1 General Considerations
		5.7.2 Acute Osteomyelitis
		5.7.3 Chronic Osteomyelitis
		5.7.4 Operative Treatment
		5.7.5 Tissue Sampling
		5.7.6 Tissue Excision
		5.7.7 Antimicrobial Therapy
		5.7.8 Dead Space Management
		5.7.9 Bone Stabilization
		5.7.10 Soft-Tissue Coverage
		5.7.11 Staging of Surgery
	5.8 Conclusion
6 Treatment of the Septic Native Joint
	6.1 Introduction
	6.2 Diagnosis
		6.2.1 Risk Factors
		6.2.2 Joint Involvement
		6.2.3 Clinical Manifestations
		6.2.4 Serum Evaluation
		6.2.5 Synovial Analysis
		6.2.6 Imaging
	6.3 Treatment
		6.3.1 Common Organisms
		6.3.2 Gonococcal Arthritis
		6.3.3 Other Pathogens
		6.3.4 Antimicrobial Therapy
		6.3.5 Surgical Treatment
		6.3.6 Needle Aspiration
		6.3.7 Arthroscopic Treatment
		6.3.8 Open Treatment
	6.4 Conclusion
7 Management of Periprosthetic Joint Infection
	7.1 Introduction
	7.2 Chronicity of Infection
	7.3 Antibiotic Management Alone
	7.4 Irrigation and Debridement
		7.4.1 Irrigation and Debridement without Polyethylene Exchange
	7.5 DAIR
	7.6 One-Stage Exchange Arthroplasty
		7.6.1 Preparation
		7.6.2 Debridement
		7.6.3 Temporary Closure
		7.6.4 New Prosthesis Implantation
		7.6.5 Outcomes of One-Stage Exchange Arthroplasty
	7.7 Two-Stage Exchange Arthroplasty
		7.7.1 First Stage: Debridement and Antibiotic Spacer Implantation
		7.7.2 Second Stage: Reimplantation
		7.7.3 Outcomes of Two-Stage Exchange Arthroplasty
	7.8 Salvage Procedures for PJI
	7.9 Conclusion
8 Infection after Fracture Fixation and Infected Nonunions
	8.1 Antibiotic Prophylaxis for Open Fractures
	8.2 Diagnosis
		8.2.1 Clinical Diagnosis
		8.2.2 Laboratory Tests
	8.3 Imaging
		8.3.1 Radiography
		8.3.2 Computed Tomography
		8.3.3 Magnetic Resonance Imaging
		8.3.4 Nuclear Medicine Studies
	8.4 Microbiology
		8.4.1 Cultures
		8.4.2 Common Organisms
	8.5 Surgical Treatment
		8.5.1 Irrigation Solutions
		8.5.2 Pin Tract Infections
		8.5.3 Irrigation and Debridement with Hardware Retention
		8.5.4 Irrigation and Debridement with Hardware Removal
		8.5.5 Irrigation and Debridement and Revision Fracture Surgery—One-Stage
		8.5.6 Irrigation and Debridement with Hardware Removal and Antibiotic Spacer Placement—Two-Stage
	8.6 Soft-Tissue Coverage
	8.7 Antibiotics
	8.8 Conclusion
9 Spine Infections
	9.1 Spinal Epidural Abscesses
		9.1.1 Introduction and Epidemiology
		9.1.2 Anatomy and Pathogenesis
		9.1.3 Presentation and Diagnosis
		9.1.4 Management and Surgical Decision-Making
		9.1.5 Prognosis
	9.2 Vertebral Osteomyelitis and Diskitis
		9.2.1 Introduction and Epidemiology
		9.2.2 Anatomy and Pathogenesis
		9.2.3 Presentation and Diagnosis
		9.2.4 Management and Surgical Decision-Making
		9.2.5 Prognosis
	9.3 Conclusion
10 Graft Infections
	10.1 Introduction
	10.2 Risk Factors for Graft Infection
		10.2.1 The Effect of Graft Type on Rates of Postoperative Infection
	10.3 Clinical Presentation and Management
		10.3.1 Clinical Presentation
		10.3.2 Laboratory Evaluation
		10.3.3 Surgical Site Infection versus Intra-articular Graft Infection
		10.3.4 Organisms Responsible for Graft Infection
	10.4 Management of Graft Infection
		10.4.1 Nonsurgical Management
		10.4.2 Surgical Management of Graft Infection
		10.4.3 Graft Retention
		10.4.4 Hardware Retention
		10.4.5 Graft Replantation
		10.4.6 Antibiotic Management
	10.5 Outcomes and Complications
		10.5.1 Recurrent Instability and Reoperation
		10.5.2 Patient Reported Outcomes Following Graft Infection
		10.5.3 Graft Infection Cost
	10.6 Graft Infection Prevention
		10.6.1 Intraoperative Graft Antibiotics
	10.7 Intraoperative Autograft Contamination
	10.8 Conclusion
Index
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