Humanitas Clinical and Research Center, Milan, Italy
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Humanitas Clinical and Research Center, Milan, Italy
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Humanitas Clinical and Research Center, Milan, Italy
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should not be used for screening, but rather as a confirmatory test for PJI. 27 Conclusion Synovial biomarkers have shown encouraging results and they should be used as diagnostic adjuncts to synovial white cell count and culture bacteriology
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-related issues. CT, MRI and ultrasonography have limited utility due to prosthesis artefacts and the fact of being operator-dependent. 24 , 25 Synovial biomarkers In the last decade, great interest has arisen over the diagnostic accuracy of synovial
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Essential treatment methods for infected knee arthroplasty involve DAIR (debridement, antibiotics, and implant retention), and one and two-stage exchange arthroplasty.
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Aggressive debridement with the removal of all avascular tissues and foreign materials that contain biofilm is mandatory for all surgical treatment modalities.
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DAIR is a viable option with an acceptable success rate and can be used as a first surgical procedure for patients who have a well-fixed, functioning prosthesis without a sinus tract for acute-early or late-hematogenous acute infections with no more than four weeks (most favourable being < seven days) of symptoms. Surgeons must focus on the isolation of the causative organism with sensitivities to bactericidal treatment as using one-stage exchange.
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One-stage exchange is indicated when the patients have:
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minimal bone loss/soft tissue defect allowing primary wound closure,
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easy to treat micro-organisms,
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absence of systemic sepsis and
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absence of extensive comorbidities.
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There are no validated serum or synovial biomarkers to determine optimal timing of re-implantation for two-stage exchange.
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Antibiotic-free waiting intervals and joint aspiration before the second stage are no longer recommended. The decision to perform aspiration should be made based on the index of suspicion for persistent infection.
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Re-implantation can be performed when the treating medical team feels that the clinical signs of infection are under control and serological tests are trending downwards.
Cite this article: EFORT Open Rev 2020;5:672-683. DOI: 10.1302/2058-5241.5.190069
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Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Austria
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falsely elevated in the early postoperative period (6 weeks) and in patients with a periprosthetic fracture, dislocation, crystal arthropathy or rheumatoid arthritis ( 5 ). In recent decades, new synovial biomarkers have been investigated to optimise the
