ArticleSICOT-J2020
Medical innovations to maintain the function in patients with chronic PJI for whom explantation is not desirable: a pathophysiology-, multidisciplinary-, and experience-based approach.
Article in SICOT-J, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 13 citations in OpenAlex.
- Phage therapy in revision arthroplasty: State of the art and application protocols.Arthroplasty (London, England) · 2026Review
- Impact of unplanned second debridement, antibiotics and implant retention on long-term outcomes in knee exchange arthroplasty: Elevated risk of failure and reinfection.Journal of experimental orthopaedics · 2024Article
- A Review of Phage Therapy for Bone and Joint Infections.Methods in molecular biology (Clifton, N.J.) · 2024Review
- Article
- Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review.SICOT-J · 2024Article
- Local Antibiotic Delivery Options in Prosthetic Joint Infection.Antibiotics (Basel, Switzerland) · 2023Review
- The Definition of the Term "Orthogeriatric Infection" for Periprosthetic Joint Infections.Geriatric orthopaedic surgery & rehabilitation · 2022Article
- Past and Future of Phage Therapy and Phage-Derived Proteins in Patients with Bone and Joint Infection.Viruses · 2021Review
- Article
- Diagnosis and management of infected arthroplasty.SICOT-J · 2021Article
- The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus.Journal of bone and joint infection · 2021Article
- Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPJI is the most dramatic complication after joint arthroplasty. In patients with chronic infection, prosthesis exchange is in theory the rule. However, this surgical approach is sometimes not desirable especially in elderly patients with multiple comorbidities, as it could be associated with a dramatic loss of function, reduction of the bone stock, fracture, or peroperative death. We propose here to report different approaches that can help to maintain the function in such patients based on a pathophysiology-, multidisciplinary-, and an experience-based approach.
methodsWe describe the different points that are needed to treat such patients: (i) the multidisciplinary care management; (ii) understanding the mechanism of bacterial persistence; (iii) optimization of the conservative surgical approach; (iv) use of suppressive antimicrobial therapy (SAT); (v) implementation of innovative agents that could be used locally to target the biofilm.
resultsIn France, a nation-wide network called CRIOAc has been created and funded by the French Health ministry to manage complex bone and joint infection. Based on the understanding of the complex pathophysiology of PJI, it seems to be feasible to propose conservative surgical treatment such as "debridement antibiotics and implant retention" (with or without soft-tissue coverage) followed by SAT to control the disease progression. Finally, there is a rational for the use of particular agents that have the ability to target the bacteria embedded in biofilm such as bacteriophages and phage lysins. DISCUSSION: This multistep approach is probably a key determinant to propose innovative management in patients with complex PJI, to improve the outcome.
conclusionConservative treatment has a high potential in patients with chronic PJI for whom explantation is not desirable. The next step will be to evaluate such practices in nation-wide clinical trials.
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