PJI with Sepsis, a Complex Emergency Situation with Prodromal Stage ()
Affiliation(s)
1Clinic of Septic Bone and Soft-Tissue Surgery, Schön-Klinik Hamburg Eilbek, Hamburg, Germany.
2Departamento de Inmunología, Facultad de Medicina, UANL, Monterrey, Mexico.
3Departement of Microbiology and Virology, Labor Fenner, Hamburg, Germany.
ABSTRACT
Introduction: With a considerable morbidity, mortality and a high financial impact,
PJI has been considered as one of the most serious complications after
arthroplasty. Special awareness must be given to these patients due to a life
threatening systemic PJI related complication, sepsis. A prompt detection and
adequate medical management of this situation is crucial for avoiding unfavorable
outcomes. Methods: Between January 2011 and December 2012, we retrospectively
examined adult patients who met PJI-SIRS criteria. Medical history search for patients’ anamnesis, surgical times, laboratory-microbiological
findings and success rates was performed. Results: Twenty patients were
enrolled in this study with a mean age of 71.35 years. Men population was more
commonly affected with 55% of the cases. The knee was mainly the affected joint
with 52%. A severe systemic disease was present in 80% of the cases. A sickness sensation and pain were the
most common prodromal symptoms found 4.9 days before the admission to the
hospital. In 85.7% of the cases the etiological agent was identified,
with Staphylococcus aureus as
the most common. Two-stage
surgery treatment was performed with a time interval between admission and the
first operation of 5.45 h. The
mean time during the first and second operation was of 23 minutes and 117
minutes respectively. A reduction on microbiological positive cultures was found
after the first rapid operation (P =
0.0038). Serum CRP levels and fever disappearance were the first
parameters which indicated a favorable disease evolution after the first operation (P = 0.0137) and
(P = 0.0181) respectively. A successful management was possible in 90% of the cases. Conclusion: Sepsis in
patients with PJI announces itself early through the leading symptoms of feeling
sick and pain in the affected joint. This time interval should be used therapeutically and diagnostically to prevent the complication of a life-threatening sepsis at best.
Share and Cite:
Haustedt, N. , Chapa, J. and Hentschke, M. (2020) PJI with Sepsis, a Complex Emergency Situation with Prodromal Stage.
Open Journal of Orthopedics,
10, 203-220. doi:
10.4236/ojo.2020.109023.