Periprosthetic Joint Infections

Abstract

Implantation of joint prostheses is becoming increasingly common, especially for the hip and knee. Infection is considered to be the most devastating of prosthesis-related complications, leading to prolonged hospitalization, repeated surgical intervention, and even definitive loss of the implant. The main risk factors to periprosthetic joint infections (PJIs) are advanced age, malnutrition, obesity, diabetes mellitus, HIV infection at an advanced stage, presence of distant infectious foci, and antecedents of arthroscopy or infection in previous arthroplasty. Joint prostheses can become infected through three different routes: direct implantation, hematogenic infection, and reactivation of latent infection. Gram-positive bacteria predominate in cases of PJI, mainly Staphylococcus aureus and Staphylococcus epidermidis. PJIs present characteristic signs that can be divided into acute and chronic manifestations. The main imaging method used in diagnosing joint prosthesis infections is X-ray. Computed tomography (CT) scan may assist in distinguishing between septic and aseptic loosening. Three-phase bone scintigraphy using technetium has high sensitivity, but low specificity. Positron emission tomography using fluorodeoxyglucose (FDG-PET) presents very divergent results in the literature. Definitive diagnosis of infection should be made by isolating the microorganism through cultures on material obtained from joint fluid puncturing, surgical wound secretions, surgical debridement procedures, or sonication fluid. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic infections in arthroplasty cases. Treatment in a single procedure is appropriate in carefully selected cases.

Is there an association between periprosthetic joint infection and low vitamin D levels?

“…T-helper type 2 cells primarily play a role in response to extracellular pathogens, such as most bacteria and parasites that cause periprosthetic joint infection. Gram-positive bacteria, mainly Staphylococcus aureus and S. epidermidis, predominate in cases of joint prosthesis contamination, but infections are also caused by Gram-positive bacilli and fungi [22]. In vitro studies proved vitamin D 3 has inhibitory activity on strains of S. aureus, Streptococcus pyogenes, Klebsiella pneumoniae and Escherichia coli, as well as other bacteria.…”

Aggressive Early Debridement in Treatment of Acute Periprosthetic Joint Infections After Hip and Knee Replacements

“…At least 3 and preferably 5-6 periprosthetic intraoperative tissue samples, joint fluid sample and the explanted component itself should be sent to the microbiology lab for aerobic and anaerobic cultures [2, 15, 16, 45, 46]. The samples should be collected from areas that macroscopically appear infected based on the clinical suspicion of the surgeon; these should include superficial, deep and periprosthetic tissues [2].…”

Mapping bacterial biofilms on recovered orthopaedic implants by a novel agar candle dip method

“…Despite the devastating complications and economic burden of treatment for periprosthetic joint infection (PJI), relatively little work has effectively mapped bacterial biofilm formation on individual components . Well‐documented work has shown the predominance of Gram‐positive bacteria in such infections (such as Staphylococcus aureus and Staphylococcus epidermidis ) . There is increasing evidence showing the formation of biofilms and is a mechanism of chronic infection and tolerance to antibiotic therapy .…”