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Review
. 2019 Jul 29;4(7):482-494.
doi: 10.1302/2058-5241.4.180092. eCollection 2019 Jul.

Periprosthetic joint infection: current concepts and outlook

Petra Izakovicova  1 , Olivier Borens  2 , Andrej Trampuz  3
Affiliations
Review

Periprosthetic joint infection: current concepts and outlook

Petra Izakovicova et al. EFORT Open Rev. .

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.

Keywords: arthroplasty; biofilm; diagnosis; periprosthetic joint infection; treatment.

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Conflict of interest statement

ICMJE Conflict of interest statement: OB reports board membership as the incoming president of Swiss Orthopaedics, consultancy for Medacta, Heraeus, Stryker and Orthofix, receiving grants or grants pending from Orthofix, Lima, Medacta and Matthys, payment for lectures including service on speakers bureaus from Lima, Medacta, Orthofix and Stryker, all outside the published work. AT reports board membership of and a research grant from Heraeus Medical, grants or grants pending from Zimmer Biomet, payment for lectures including service on speakers bureaus from InfectoPharm and providing educational material to PRO-IMPLANT Foundation, all outside the published work.

Figures

Table 1.
Table 1.
Definition of periprosthetic joint infection Periprosthetic joint infection is diagnosed, if ⩾ 1 criterion is fulfilled.
Table 2.
Table 2.
Classification of periprosthetic joint infection (PJI)
Fig. 1
Fig. 1
Diagnostic algorithm for PJI. Reproduced with permission from the Pocket Guide to Diagnosis & Treatment of PJI, PRO-IMPLANT Foundation (version 9, October 2019). Notes. CRP, C-reactive protein.
Fig. 2
Fig. 2
Treatment algorithm for PJI. Reproduced with permission from the Pocket Guide to Diagnosis & Treatment of PJI, PRO-IMPLANT Foundation (version 9, October 2019). Notes. CRP, C-reactive protein.
Table 3.
Table 3.
Local antimicrobials in bone cement (PMMA) (additionally to systemic antimicrobial treatment)
Fig. 3
Fig. 3
Overview of surgical procedures for PJI. Reproduced with permission from the Pocket Guide to Diagnosis & Treatment of PJI, PRO-IMPLANT Foundation (version 9, October 2019).
Table 4.
Table 4.
Recommended antimicrobial treatment
See this image and copyright information in PMC

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