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Management of Infected Orthopedic Joint Implants: Pertinent Information for Family Medicine Physicians

Gomez MM, Manrique J and Chen AF

Periprosthetic joint infections (PJIs) are one of the most devastating complications after total joint replacement. An early diagnosis can improve the outcome of treating PJI, and the first steps for diagnosing PJI are often conducted by a family doctor or a general practitioner.

When a patient presents with a suspicion for PJI, the steps that must be followed are based on the clinical practice guideline by the American Academy of Orthopedic Surgeons (AAOS). Clinical symptoms, such as pain, are the main complaint that alerts physicians to a potential PJI, along with other symptoms such as erythema, warmth and tenderness around the surgical wound. These patients should receive x-rays of the affected joint, and laboratory tests such as erythrocyte sedimentation rate and C-reactive protein should be drawn. Physicians should actively avoid starting antibiotic therapy, obtaining nuclear medicine imaging, sending patients to infectious disease, or prescribing physical therapy. Finally, patients with a suspicion for PJI must be referred to an orthopedic surgeon who can establish the final diagnosis and conduct appropriate treatment.