Date:
Patient:
Reason for Visit:
Follow-up for suspected or confirmed prosthetic joint infection (PJI)
Evaluation of new symptoms or worsening of existing ones
Management plan discussion
History:
Past Medical History (PMH):
Underlying condition requiring joint replacement (e.g., osteoarthritis, rheumatoid arthritis)
Type of prosthetic joint (hip, knee, shoulder, etc.)
Date of joint replacement surgery
Any prior surgeries on the same joint
Immunosuppressive conditions or medications
Medications:
Current antibiotics (if any)
Pain medications
Social History:
Recent hospitalizations, surgeries, or dental procedures (potential sources of infection)
Intravenous drug use (risk factor for infection)
Presenting Complaint:
Describe the patient’s current concerns and symptoms, including onset, duration, and severity.
Examples: joint pain (increased or new onset), swelling, redness, warmth, drainage from the surgical site, fever, chills, difficulty walking (if lower extremity joint)
Functional Status:
Assess patient’s ability to perform daily activities (limitations due to pain or swelling)
Physical Exam:
Vital Signs: Assess blood pressure, heart rate, oxygen saturation, and temperature (elevated temperature may suggest infection).
General: Look for signs of systemic infection (sweating, malaise).
Musculoskeletal:
Inspect the affected joint for swelling, redness, warmth, and drainage.
Assess joint range of motion and stability.
Compare findings to the unaffected joint.
Diagnostic Tests:
Laboratory Tests:
Complete blood count (CBC) – elevated white blood cells may suggest infection
C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR) – inflammatory markers elevated in infection
Synovial fluid analysis:
White blood cell count and differential – elevated white blood cells with predominance of neutrophils suggest infection
Gram stain and cultures – to identify any bacteria or other pathogens
Imaging Tests:
X-ray: may show signs of loosening of the prosthetic joint (indirect sign of PJI)
White blood cell scan (WBC scan) – may show increased uptake of radioisotope in the infected joint
MRI scan (may be more sensitive than X-ray) – may show bone destruction or fluid collection around the joint
Assessment:
Clinical suspicion for PJI: Based on symptoms, physical exam findings, and laboratory tests.
Diagnostic confirmation of PJI: Requires a combination of clinical findings, laboratory tests, and synovial fluid analysis with positive cultures.
Stage of infection (if confirmed PJI): Early, acute, chronic, or periprosthetic joint infection (around the prosthesis but not involving it directly).
Microbiology (if identified): The specific organism causing the infection
Plan:
Antibiotic Treatment:
Intravenous antibiotics for initial management (typically 6-8 weeks)
Followed by oral antibiotics to complete the treatment course (duration depends on severity and organism)
Consider specialist consultation for complex antibiotic regimens or resistant organisms.
Surgical Management (may be necessary):
Debridement and irrigation (removal of infected tissue and irrigation with antibiotics)
Possible removal and replacement of the prosthetic joint (depending on severity and success of antibiotic treatment)
Referral to an orthopedic surgeon specializing in PJI for complex cases.
Pain Management: Medications to manage pain and inflammation.
Physical Therapy: Rehabilitation to regain joint function and mobility.
Patient education: Provide information about PJI, treatment options, potential complications, importance of medication adherence, and signs and symptoms to watch for.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of prosthetic joint infection