Infection of native and prosthetic joints

This chapter describes infections of native and prosthetic joints. Infections of native joints generally occur in patients with predisposing factors such as trauma, underlying arthritis, immunosuppressive therapy, diabetes mellitus, malignancies, intravenous drug abuse, and other infections. Hematogenous spread of the organism through the highly vascular synovial space leads to an influx of polymorphonuclear leukocytes (PMLs) into the synovium and then to a release of enzymes that destroy the articular surface. Empiric antimicrobial therapy for suspected bacterial arthritis is started after obtaining appropriate fluid specimens for analysis and culture. The choice of antibiotics depends on the patient's age, risk factors, and results of the synovial fluid Gram stain. The antibiotics are modified after obtaining the culture results. Meanwhile, the object of successful management of prosthetic joint infections is 2-fold: eradication of infection and maintenance of functional integrity of the joint.