Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 5;77(7):e34-e45.
doi: 10.1093/cid/ciad360.

Periprosthetic Joint Infection: Current Clinical Challenges

Sandra B Nelson  1 , Jodian A Pinkney  1 , Antonia F Chen  2 , Aaron J Tande  3
Affiliations

Periprosthetic Joint Infection: Current Clinical Challenges

Sandra B Nelson et al. Clin Infect Dis. .

Abstract

Over the last several decades, periprosthetic joint infection has been increasing in incidence and is occurring in more complex patients. While there have been advances in both surgical and medical treatment strategies, there remain important gaps in our understanding. Here, we share our current approaches to the diagnosis and management of periprosthetic joint infection, focusing on frequent clinical challenges and collaborative interdisciplinary care.

Keywords: antimicrobial treatment; periprosthetic joint infection; revision arthroplasty; rifampin; total joint arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest . S. B. N. reports honorarium from the Infectious Diseases Board Review Course (George Washington University CME) paid to author; participation on Journal of Bone and Joint Infection’s Advisory Board; a role on the education committee for the Musculoskeletal Infection Society; and stock options from Sonoran Biosciences. A. J. T. reports royalties from UpToDate and an unpaid position with the Musculoskeletal Infection Society. A. F. C. reports grants or contracts from the Clinical Process Improvement Leadership Program, Foundation for Arthroplasty Research and Education, National Institutes of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases, Knee Society, Vela Foundation, Ruth Jackson Orthopaedic Society/Zimmer Biomet Clinical/Basic Science Research Grant, Orthopaedic Trauma Association, Agency for Healthcare Research and Quality and Patient Centered Outcomes Research Initiative Large Conference Grant Program, American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Quality and Patient Safety Action Fund, and Centers for Medicare and Medicaid Services; consulting fees from Adaptive Phage Therapeutics, Avanos, Best In Class MD, Convatec, Ethicon, Gerson Lehrman Group, Guidepoint, Heraeus, IrriMax, Peptilogics, Pfizer, Stryker, and Smith and Nephew; board or committee positions with AAOS, American Joint Replacement Registry, American Association of Hip and Knee Surgeons, and the European Knee Association; stock or stock options from Hyalex, IrriMax, Osteal Therapeutics, Sonoran, IlluminOss; a grant from Ruth Jackson Orthopaedic Society/Zimmer Biomet; royalties from Stryker, SLACK Incorporated, and UpToDate; and editorial board roles for the following publications: Journal of Bone and Joint Surgery; Journal of Arthroplasty; Clinical Orthopaedics and Related Research; Journal of Bone and Joint Infection; Knee Surgery, Sports Traumatology, Arthroscopy; Journal of Orthopaedic Research; and Anthroplasty Today. The remaining author: No reported conflicts of interest. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Interdependence of surgical and antimicrobial management, with suggested antimicrobial treatment protocols.Figure 1 has been reprinted with permission from the American Society of Microbiology in a modified format [Tande AJ and Patel R. Prosthetic joint infection. Clinical Microbiology Reviews 2014; 27(2): 302–345]. Abbreviations: ALC, antimicrobial-loaded cement; DAIR, debridement, antibiotics, and implant retention; IV, intravenous.
Figure 2.
Figure 2.
Articulating spacers for use following the first stage of a 2-stage exchange arthroplasty. A, Articulating hip spacer. B, Articulating knee spacer. Abbreviation: PMMA, polymethylmethacrylate.
Figure 3.
Figure 3.
Schematic image of the Prostalac Hip System. Image reprinted with permission from DePuy Synthes.
None
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Kurtz SM, Lau EC, Son M-S, Chang ET, Zimmerli W, Parvizi J. Are we winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the Medicare population. J Arthroplasty 2018; 33:3238–45. - PubMed
    1. McMaster Arthroplasty Collaborative . Incidence and predictors of prosthetic joint infection following primary total knee arthroplasty: a 15-year population-based cohort study. J Arthroplasty 2022; 37:367–372.e1. - PubMed
    1. McMaster Arthroplasty Collaborative . Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a 15-year, population-based cohort study. J Bone Joint Surg Am 2020; 102:503–9. - PubMed
    1. Premkumar A, Kolin DA, Farley KX, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 2021; 36:1484–1489.e3. - PubMed
    1. Schwartz AM, Farley KX, Guild GN, Bradbury TL. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty 2020; 35:S79–85. - PMC - PubMed

Publication types

MeSH terms