Prosthetic joint infection

Abstract

Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.

FIG 1

The Mayo prosthetic joint infection risk score. The baseline or 1-month postsurgery score is calculated, and the predicted probability of PJI is determined by using the accompanying curve. (Reproduced from reference with permission.)

FIG 2

Schematic showing a total hip arthroplasty in place, with relevant structures highlighted.

FIG 3

Prosthesis sonication protocol used in the Mayo Clinic Clinical Microbiology Laboratory. (Courtesy of David Lynch, reproduced with permission.)

FIG 4

Medical and surgical strategies for management of prosthetic joint infection. Outlined arrows indicate exchange of polyethylene components only, solid arrows indicate exchange of all arthroplasty components, and dotted arrows indicate exchange of cement spacer. The use of suppressive antimicrobials after DAIR or one-stage arthroplasty exchange is controversial. Management of PJI without surgery is not generally recommended. Abbreviations: DAIR, debridement, antibiotics, and implant retention; OSE, one-stage exchange; ALC, antimicrobial-loaded cement; PJI, prosthetic joint infection; IV, intravenous.