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Chronic Prosthetic Joint Infection — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionChronic Prosthetic Joint InfectionSCE Infectious Diseases

A 60-year-old man develops a prosthetic hip joint infection 3 years after implantation. The joint has been painful for 4 months with a draining sinus. Deep tissue cultures grow Staphylococcus aureus (MSSA). What is the most appropriate surgical strategy?

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Correct answer: B — Two-stage revision arthroplasty (prosthesis removal, antibiotic spacer, 6-week IV antibiotics, then reimplantation)

Chronic PJI (symptoms >3 weeks duration or late haematogenous presentation >3 months post-implant) with a draining sinus requires prosthesis removal because biofilm is well-established and cannot be eradicated with DAIR. Two-stage revision is the gold standard for chronic PJI: first stage involves prosthesis removal, thorough debridement, and insertion of an antibiotic-impregnated spacer plus 6 weeks of IV antibiotics; second stage involves reimplantation after infection is controlled (usually 6–12 weeks). DAIR is only appropriate for early PJI (<3 months, symptoms <3 weeks).

Reference: BSAC 2023 – PJI guidelines; NICE NG157 2024 – Joint replacement infections