Bone and Joint Infections

Werner Zimmerli, MD, is Professor in Internal Medicine and Infectious Diseases at Basel University Medical Clinic, Liestal, Switzerland.

Contributors xiii


Foreword xvii


Acknowledgments xix


Chapter 1 Introduction 1
Werner Zimmerli


Chapter 2 Microbiology of Bone and Joint Infections 5
Seong Yeol Ryu and Robin Patel


Microorganisms in Osteomyelitis 5


Microorganisms in Implant-Associated Bone and Joint Infection 7


Microorganisms in Native Joint Arthritis 10


Diagnostic Approach in Osteomyelitis 11


Diagnostic Approach in Foreign Body–Associated Infection 12


Diagnostic Approach in Native Joint Infection 15


Novel Diagnostic Procedures 17


Acknowledgment 17


References 17


Chapter 3 Pharmacokinetics and Pharmacodynamics of Antibiotics in Bone 21
Cornelia B. Landersdorfer, Jürgen B. Bulitta, and Fritz Sörgel


Pharmacokinetics 21


Bone Sample Preparation and Analysis 22


Pharmacokinetic Sampling and Data Analysis 23


Penetration of Antibiotics into Bone 24


Pharmacodynamics and Monte Carlo Simulations 31


Conclusions 34


Key Points 34


References 35


Chapter 4 Preclinical Models of Infection in Bone and Joint Surgery 39
Lorenzo Calabro, R. Geoff Richards, and T. Fintan Moriarty


Introduction 39


Influence of Species in Preclinical Models of Bone and Joint Infection 40


Overview of Animal Models 42


Direct Inoculation with Minimal Trauma 42


Animal Osteomyelitis Models Incorporating Trauma 46


Hematogenous Models 47


Future Directions 48


Conclusion 49


Key Points 49


References 49


Chapter 5 Native Joint Arthritis in Children 55
Pablo Yagupsky


Introduction 55


Epidemiology 55


Microbiology 56


Pathogenesis 61


Clinical Presentation 62


Laboratory Investigation 63


Imaging Studies 66


Differential Diagnosis 66


Treatment 67


Prognosis 71


Key Points 72


References 72


Chapter 6 Native Joint Arthritis 77
Ilker Uçkay, Mohamed Al-Mayahi, Domizio Suvà, Daniel Lew, and Pierre Vaudaux


Introduction 77


Pathogenesis, Epidemiology, and Microbiology 77


Diagnosis 79


Treatment 81


Outcome of Native Joint Septic Arthritis 87


Key Points 88


Acknowledgments 88


References 88


Chapter 7 Septic Arthritis of Axial Joints 93
Werner Zimmerli


Septic Arthritis of the Sternoclavicular Joint 93


Key Points 98


Septic Arthritis of the Symphysis Pubis 98


Key Points 103


Septic Arthritis of the Sacroiliac Joint 103


Key Points 107


References 107


Chapter 8 Periprosthetic Joint Infection: General Aspects 113
Werner Zimmerli


Introduction 113


Definition 114


Classification 115


Pathogenesis 115


Diagnostic Algorithm 118


Laboratory Investigation 119


Therapeutic Management 121


Prophylaxis 122


Errors in the Management of PJI 123


Key Points 124


References 124


Chapter 9 Periprosthetic Joint Infection after Total Hip and Knee Arthroplasty 131
Werner Zimmerli and Martin Clauss


Introduction 131


Risk Factors 131


Microbiology 132


Clinical Features 133


Laboratory Investigation 133


Imaging Procedures 134


Management 135


Instructive Cases 142


References 146


Chapter 10 Periprosthetic Joint Infection after Shoulder Arthroplasty 151
Parham Sendi, Beat K. Moor, and Matthias A. Zumstein


Introduction 151


Risk Factors 151


Microbiology 153


Pathogenesis 154


Clinical Features 154


Laboratory Investigation 155


Imaging Procedures 157


Management 158


Instructive Cases 162


References 163


Chapter 11 Periprosthetic Joint Infection after Elbow Arthroplasty 167
Yvonne Achermann and Michael C. Glanzmann


Introduction 167


Microbiology 168


Clinical Features 168


Diagnostic Procedures 169


Instructive Cases 176


References 179


Chapter 12 Periprosthetic Joint Infection after Ankle Arthroplasty 183
Parham Sendi, Bernhard Kessler, and Markus Knupp


Introduction 183


History of Total Ankle Arthroplasty 184


Risk Factors 185


Microbiology 186


Management 189


Instructive Cases 192


References 194


Chapter 13 Osteomyelitis: Classification 197
Werner Zimmerli


Classification According to Pathogenesis 197


Classification According to the Duration of Infection 199


Classification According to the Localization 200


Classification According to the Presence of an Implant 200


Classification According to Anatomy and Comorbidity 200


References 201


Chapter 14 Osteomyelitis in Children 205
Priya Sukhtankar, Saul N. Faust, and Nicholas M.P. Clarke


Introduction 205


Epidemiology 205


Pathophysiology 206


Clinical Presentation, Diagnosis, and Microbiology 207


Treatment 214


Complications 217


Key Points 217


References 217


Chapter 15 Acute Osteomyelitis in Adults 221
Werner Zimmerli


Introduction 221


Pathogenesis 221


Epidemiology 223


Microbiology 224


Risk Factors 225


Clinical Features 227


Laboratory Investigation 229


Imaging Procedures 231


Clinical and Imaging Differential Diagnosis 232


Treatment 233


Key Points 236


References 236


Chapter 16 Subacute Osteomyelitis: Tuberculous and Brucellar Vertebral Osteomyelitis 241
Juan D. Colmenero and Pilar Morata


Introduction 241


Epidemiology 241


Clinical Features 242


Laboratory Investigation 244


Imaging Procedures 247


Antimicrobial and Surgical Therapy 250


Key Points 252


References 252


Chapter 17 Chronic Osteomyelitis in Adults 257
Silvin Lito, Antoine Lomessy, Pierre Vaudaux, and Ilker Uçkay


Introduction 257


Epidemiology and Pathogenesis 259


Diagnosis 260


Treatment 262


Future Perspectives 268


Key Points 268


Acknowledgments 269


References 269


Chapter 18 Diabetic Foot Osteomyelitis 273
Eric Senneville and Sophie Nguyen


Introduction 273


Classification 273


Microbiology 276


Risk Factors 278


Clinical Features 279


Inflammatory Parameters 279


Imaging Procedures 280


Management 281


Prevention 284


References 284


Chapter 19 Osteomyelitis of the Jaws 289
Werner Zimmerli


Introduction 289


Classification 289


Microbiology 291


Risk Factors 292


Clinical Features 292


Laboratory Investigation 294


Imaging Procedures 296


Management 297


Key Points 299


References 299


Chapter 20 Implant-Associated Osteomyelitis of Long Bones 303
Martin McNally and Parham Sendi


Introduction 303


Classification and Risk Factors 304


Microbiology 306


Clinical Features 306


Laboratory Investigation 307


Imaging Procedures 309


Management 309


Instructive Cases 317


References 320


Chapter 21 Implant-Associated Vertebral Osteomyelitis 325
Todd J. Kowalski


Introduction 325


Epidemiology, Risk Factors, and Preventive Measures 326


Microbiology 327


Clinical Features 331


Diagnostic Procedures 332


Management 333


Instructive Cases 339


References 341


Chapter 22 Postoperative Sternal Osteomyelitis 347
Parham Sendi, Örjan Friberg, Mihai A. Constantinescu, and Lars Englberger


Introduction 347


Risk Factors 348


Microbiology 351


Clinical Features 352


Laboratory Investigation 354


Imaging Procedures 355


Management 356


Instructive Cases 360


References 362


Index 367