PJI with Sepsis, a Complex Emergency Situation with Prodromal Stage

Introduction: With a considerable morbidity, mortality and a high financial impact, PJI has been considered as one of the most serious complications after arthroplasty. Special awareness must be given to these patients due to a life threatening systemic PJI related complication, sepsis. A prompt detection and adequate medical management of this situation is crucial for avoiding unfavorable outcomes. Methods: Between January 2011 and December 2012, we retrospectively examined adult patients who met PJI-SIRS criteria. Medical history search for patients’ anamnesis, surgical times, laboratory-microbiological findings and success rates was performed. Results: Twenty patients were enrolled in this study with a mean age of 71.35 years. Men population was more commonly affected with 55% of the cases. The knee was mainly the affected joint with 52%. A severe systemic disease was present in 80% of the cases. A sickness sensation and pain were the most common prodromal symptoms found 4.9 days before the admission to the hospital. In 85.7% of the cases the etiological agent was identified, with Staphylococcus aureus as the most common. Two-stage surgery treatment was performed with a time interval between admission and the first operation of 5.45 h. The mean time during the first and second operation was of 23 minutes and 117 minutes respectively. A reduction on microbiological positive cultures was found after the first rapid operation (P = 0.0038). Serum CRP levels and fever disappearance were the first parameters which indicated a favorable disease evolution after the first operation (P = 0.0137) and (P = 0.0181) respectively. A successful management was possible in 90% of the cases. Conclusion: Sepsis in patients with PJI announces itself early through the leading symptoms of feeling sick and pain in the affected joint. This time interval should be used therapeutically and diagnostically to prevent the complication of a life-threatening sepsis at best.