Periprosthetic joint infection: current concepts and outlook

Abstract

Periprosthetic joint infection (PJI) is a serious complication occurring in 1% to 2% of primary arthroplasties, which is associated with high morbidity and need for complex interdisciplinary treatment strategies. The challenge in the management of PJI is the persistence of micro-organisms on the implant surface in the form of biofilm. Understanding this ability, the phases of biofilm formation, antimicrobial susceptibility and the limitations of host local immune response allows an individual choice of the most suitable treatment. By using diagnostic methods for biofilm detection such as sonication, the sensitivity for diagnosing PJI is increasing, especially in chronic infections caused by low-virulence pathogens. The use of biofilm-active antibiotics enables eradication of micro-organisms in the presence of a foreign body. The total duration of antibiotic treatment following revision surgery should not exceed 12 weeks.Cite this article: EFORT Open Rev 2019;4:482-494. DOI: 10.1302/2058-5241.4.180092

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

“…Treatment of an infected prosthesis should be tailored to the type of infection (early/acute or late/chronic infection), the causative micro-organism, the quality of the soft tissue envelope, stability of the implant, surgeon experience, and ultimately host factors (comorbidities and functional status) and patient preferences [55,56]. In acute PJI, the duration of symptoms is less than three weeks (haematogenous or contiguous infections) or four weeks (early post-operative infections); all other infections with longer duration of symptoms are defined as chronic PJI (Table 1) [6].…”

Comparison of sonication with chemical biofilm dislodgement methods using chelating and reducing agents: Implications for the microbiological diagnosis of implant associated infection

“…Comparison of sonication with chemical biofilm dislodgement methods fracture-fixation device-associated infections and up to 15% of neurosurgical shunt-associated infections [2][3][4][5]. The chosen P. aeruginosa strain was shown to be a good biofilm producer in previous biofilm studies [24].…”

“…Introduction Implants are increasingly used to improve the mobility (joint replacement and bone fixation devices) or prolong the survival and assist the performance of physiological functions (cardiac implantable electronic device (CIED) and neurosurgical shunts). Infections represent a significant complication of implant surgery, resulting in major challenges regarding the diagnosis and treatment [1][2][3][4][5]. Most commonly isolated microorganisms in patients with periprosthetic joint infection are coagulase-negative staphylococci (30-45%) and Staphylococcus aureus (12-23%), followed by streptococci (9-10%), enterococci (3-7%), gram-negative bacilli (3-6%) and anaerobes (2-4%) [6].…”

Antibiotic-Loaded Hydrogel Coating to Reduce Early Postsurgical Infections in Aseptic Hip Revision Surgery: A Retrospective, Matched Case-Control Study

“…The primary outcome was the onset of short-term infection, expanding the classically known concept of early infection from 3 to 6 months [15]. The diagnosis of infection was made according to the criteria proposed by the European Bone and Joint Infection Society [16]. The secondary outcome assessment tools were the mobilization of the implant at the last radiographic check-up, the postoperative functionality expressed through hip disability osteoarthritis outcome score (HOOS) and the HHS.…”