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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(01): e21-e28
DOI: 10.1055/s-0043-1776019
Revisão Sistemática e Metanálise
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Diagnosis and Prevention of Periprosthetic Joint Infections by Staphylococcus aureus after Hip Fracture: A Systematic Review of the Literature

Article in several languages: português | English
Bianca Gabriella de Oliveira 
1   Departamento da Liga Acadêmica de Ortopedia e Traumatologia da UNIFACS, Universidade Salvador (UNIFACS), Salvador, BA, Brasil
,
Victor Hugo Ruis da Costa 
2   Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
,
Igor Rodrigues Gama 
2   Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
,
Murilo Halberstadt Beskow 
2   Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
,
Elisson Rafael Silva dos Santos 
2   Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
› Author Affiliations Financial Support The present study received no financial support from either public, commercial, or not-for-profit sources.
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Abstract

Hip arthroplasties are surgical procedures widely performed all over the world, seeking to return functionality, relieve pain, and improve the quality of life of patients affected by osteoarthritis, femoral neck fractures, osteonecrosis of the femoral head, among other etiologies. Periprosthetic joint infections are one of the most feared complications due to the high associated morbidity and mortality, with a high number of pathogens that may be associated with its etiology. The aim of the present study was to analyze aspects correlated with the occurrence of infection, diagnosis and prevention of periprosthetic joint infections in the hip associated with Staphylococcus aureus after corrective surgery for hip fractures. This is a systematic review of the literature carried out in the databases indexed in the Medical Literature Analysis and Retrieval System Online (MEDLINE) carried out in accordance with the precepts established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Twenty studies that addressed the diagnosis and prevention of periprosthetic joint infections after hip fractures were selected for analysis. It is observed that there is no consensus in the literature on preventive measures for the occurrence of such infectious processes. Among the risk factors for the occurrence and severity of infections by S. aureus after hip arthroplasties, obesity, longer surgical time, older age, immunosuppression, recent use of antibiotics, and multicomorbidities were mentioned. The use of biomarkers for early diagnosis, as well as screening, decolonization, and antibiotic prophylaxis processes are among the preventive procedures proposed in the literature.

Keywords

arthroplasty, replacement, hip - hip prosthesis - staphylococcal infections

Final considerations

S. aureus was reported in all selected studies as one of the major etiologic agents of PJI. In recent years, the emergence of new biomarkers that may help in the diagnosis and early management of PJI has been observed, although the studies found and discussed in the present construct have presented the reduced sample as a limiting factor. Among the new biomarkers, the AMPs in the synovial membrane of the PJI and in the synoviocytes stand out. Elevated CRP and ESR are also usually correlated with the suspected diagnosis of PJI.


As for the method to obtain culture medium, the authors highlighted the use of sonication as a superior technique in terms of specificity and sensitivity when compared with conventional periprosthetic tissue cultures.


Universal decolonization was one of the most reported preventive procedures in the studies, with its best cost-effectiveness being proven by the lower occurrence of PJI and consequent lower associated hospital cost. There was no consensus regarding nasal screening for decolonization, given that the parameters for screening were not clearly described by the studies.


Work developed at the Hospital Universitário de Canoas, Canoas, RS, Brazil.




Publication History

Received: 15 July 2022

Accepted: 08 November 2022

Article published online:
21 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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