Polymicrobial prosthetic joint infection: Unusual presentation requiring a multidisciplinary and patient centered approach to treatment

Paul M. Alvarez; Cole Veliky; John F. McKeon; Douglas J. Chonko

doi:10.1016/j.jorep.2025.100562

January 23, 2025Journal of Orthopaedic ReportsOpen Access

Polymicrobial prosthetic joint infection: Unusual presentation requiring a multidisciplinary and patient centered approach to treatment

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Key Points

To describe the clinical presentation and multidisciplinary treatment strategy for an unusual polymicrobial prosthetic joint infection following total hip arthroplasty.
Evaluated a patient presenting with an infected left total hip arthroplasty originally performed for avascular necrosis secondary to a femoral neck fracture.
Performed joint aspiration yielding eight distinct bacterial organisms, including gram-positive and gram-negative isolates.
Executed a staged multidisciplinary plan involving hardware explantation, antibiotic spacer placement, intravenous antimicrobial therapy, vascularized muscle flap reconstruction, reimplantation, and one year of oral antibiotic suppression.
Initial synovial fluid aspiration identified eight distinct bacterial pathogens comprising both gram-positive and gram-negative species.
Staged surgical debridement, antibiotic spacer insertion, and vascularized soft-tissue coverage successfully eradicated the polymicrobial infection and facilitated joint reimplantation.

Implication

Case report demonstrates successful eradication of an eight-organism prosthetic joint infection after total hip arthroplasty, highlighting the value of tailored multidisciplinary care.

Abstract

We present a case of polymicrobial prosthetic joint infection in a patient with history of left total hip arthroplasty for treatment of avascular necrosis following a femoral neck fracture. Aspiration results from the day of presentation were positive for eight total organisms, including gram-positive and gram-negative bacteria. Successful treatment of this patient's infection required a multidisciplinary approach with assistance from infectious disease, internal medicine and plastic surgery physicians. Treatment included explant with placement of an antibiotic spacer, multiple courses of intravenous antibiotics, vascularized muscle flap and reimplantation with one year of antibiotic suppression. Our case highlights both the importance of a multidisciplinary approach as well as a patient specific approach to treatment when treating patients with prosthetic joint infections.

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Cite This Study

Alvarez et al. (2025) studied this question.

synapsesocial.com/papers/6aa25e3bda8566d019e565bd https://doi.org/10.1016/j.jorep.2025.100562

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Polymicrobial prosthetic joint infection: Unusual presentation requiring a multidisciplinary and patient centered approach to treatment

Key Points

Implication

Abstract

Discussion

Cite This Study

Polymicrobial prosthetic joint infection: Unusual presentation requiring a multidisciplinary and patient centered approach to treatment

Key Points

Implication

Abstract

Discussion

Cite This Study

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