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JAC Advance Access originally published online on December 19, 2003
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Journal of Antimicrobial Chemotherapy (2004) 53, 127-129
© 2004 The British Society for Antimicrobial Chemotherapy

Leading Article

Trends in the treatment of orthopaedic prosthetic infections

Louis Bernard1,3, Pierre Hoffmeyer1, Mathieu Assal1, Pierre Vaudaux2, Jacques Schrenzel2 and Daniel Lew2,*

1 Orthopaedic Clinic and 2 Division of Infectious Diseases, Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland; 3 Division of Infectious Diseases, Garches University Hospital, 104, Boulevard R. Poincaré, 92380 Garches, France

The most commonly used therapy for prosthetic joint infection is a two-stage prosthetic exchange separated by 6 weeks of intravenous antibiotic therapy. This often results in long periods of hospitalization, morbidity, severe functional impairment and sometimes increased mortality. Therefore novel and challenging therapeutic approaches have been attempted, particularly in hip prosthetic infection. This includes, whenever possible, according to the type of microorganism, antibacterial susceptibility and clinical presentation (including age and comorbidities): (i) less aggressive surgical techniques (debridement and prosthesis retention, or re-implantation with a single-stage exchange arthroplasty); and (ii) antibiotic combinations active against biofilm-associated bacteria, including rifampicin (particularly with quinolones) with excellent bio-availability which allow prolonged and efficient oral therapy.

Keywords: total joint infection, exchange prosthesis, one-stage prosthetic reimplantation, two-stage prosthetic reimplantation

* Corresponding author. Tel: +41-22-372-33-11; Fax : +41-22-372-77-91; E-mail: daniel.lew{at}hcuge.ch


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