The Paradox of Prosthetic Joint Infection and the Microbiome: Are Some Bacteria Actually Helpful?

Abstract

Periprosthetic joint infection (PJI) is a potentially catastrophic complication of total joint arthroplasty of the lower extremity. PJI is associated with significant burden of illness and economic cost. There are a number of well-established modifiable risk factors for PJI. Myriad perioperative protocols are used with the intent of reducing the incidence of PJI. However, it remains unclear why infections occur despite correction of modifiable risk factors and/or adherence to prophylactic protocols. There is emerging evidence that the microbiome—the diverse population of commensal microorganisms that inhabit the human body—may play a role in the pathogenesis of musculoskeletal infections. The impact of the microbiome on PJI warrants further investigation and may change how we conceptualize, prevent, and treat PJI.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

“…As healthcare providers in orthopaedic surgery, we diligently endeavour to correct modifiable pre-operative patients’ vulnerabilities and enhance peri-operative experiences to mitigate the risk of complications and support patients in living a burden-free, happy, and long life after surgery. The theorised IOHN-OS incorporates oral health assessment and management before surgery, in-hospital oral hygiene and support, and both usual and innovative education programmes before and after surgery (e.g., techniques to minimise recessions, fluoride regimens, tailored antibiotic treatment that preserves “good” bacteria [ 1 ]). This integrated network has the potential to prolong an older person’s desire to smile and their ability to eat and speak over time.…”

“…The insertion of joint endoprostheses or spine stabilisers leads to good results in most patients. However, a number of cases do not properly recover, indirectly producing far-reaching human and economic consequences [ 1 ]. The common denominators in these cases are smoking, polymorbidity, and malnutrition [ 2 ].…”