BACTERIAL INFECTIONS: PDF OnlyInfection of an orthopaedic implant: epidemiology and diagnosisVogely, H. Ch.; Fleer, A.*; Dhert, W. J. A.; Verbout, A. J.Author Information University Cluster of Orthopaedics, University Medical Center Utrecht, The Netherlands, and *Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands Address for correspondence: H. Ch. Vogely, University Medical Center Utrecht, Department of Orthopaedics, Room G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Fax: +31 30 2510638. e-mail: [email protected] Reviews in Medical Microbiology: July 2000 - Volume 11 - Issue 3 - p 115-126 Buy Abstract Infection of an orthopaedic implant is a source of considerable morbidity. Infection rates for primary total hip arthroplasties have been reported to be 1-2%. Major risk factors for deep infection are rheumatoid arthritis and diabetes mellitus. Other potential risk factors have also been described. From the majority of the patients with an infected hip arthroplasty, Gram-positive microorganisms can be isolated. Coagulase-negative staphylococci andStaphy-lococcus aureusare isolated in > 50% of cases, in almost equal numbers, Gramnegative bacilli are usually secondary invaders of open, draining wounds in patients with deep sepsis of a hip arthroplasty. Anaerobic microorganisms are isolated in 10% of such patients. To facilitate the management of the patients with an infected hip arthroplasty several classification systems have been described, but none of these is universally accepted. It can be difficult to make the correct diagnosis of infected joint arthroplasty with reasonable certainty: a diagnosis can be reached with an acceptable degree of certainty only by combining various investigations. In most cases, an infection can be diagnosed or excluded on the basis of a carefully obtained clinical history and the measurement of the sedimentation rate and/or the C-reactive protein level. Other preoperative investigations, such as radiography, arthrography, radionuclide imaging, aspiration of the joint and peroperative investigations, such as frozen sections, Gram stains and cultures, may provide additional evidence. Peroperative cultures provide the most accurate diagnostic information. © 2000 Lippincott Williams & Wilkins © 2000 Lippincott Williams & Wilkins, Inc.