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Review
. 2025 Apr 10;14(8):2610.
doi: 10.3390/jcm14082610.

Unconventional Therapies in Periprosthetic Joint Infections: Prevention and Treatment: A Narrative Review

Daniyil Semeshchenko  1   2 , Pablo A Slullitel  1 , Alicia Farinati  2 , Agustin F Albani-Forneris  1 , Nicolas S Piuzzi  3 , Martin A Buttaro  1
Affiliations
Review

Unconventional Therapies in Periprosthetic Joint Infections: Prevention and Treatment: A Narrative Review

Daniyil Semeshchenko et al. J Clin Med. .

Abstract

Background: as the demand for total joint arthroplasty continues to grow each year, the healthcare burden is expected to increase due to periprosthetic joint infection (PJI). This review article aims to highlight the significance of biofilms in the pathogenesis of PJI and introduce alternative therapies that prevent bacterial adhesion to implants or enhance their eradication when infection occurs.

Search strategy: we conducted a bibliographic search in PubMed using the following MeSH terms as follows: "no antibiotic treatment of PJI", "bacterial biofilm eradication agents", and "unconventional prevention of PJI", among others. Most important results: after an initial analysis of the literature, we selected the most significant topics on novel PJI treatment methods and prevention strategies. A second PubMed search highlighted the following therapeutic modalities: the application of hydrogels on implant surfaces, the use of phage therapy, lysostaphin and antimicrobial peptides, the implementation of two-stage debridement, irrigation, implant retention and antibiotic therapy (DAIR), the intra-articular antibiotic infusion, and the use of methylene blue for biofilm eradication.

Conclusions: the use of new cement spacers with xylitol, ammonium compounds, or silver nanoparticles is another promising technique to increase the eradication rate in two-stage revision. It is important for professionals to deeply understand the pathogenesis of PJI and the role of biofilms in its development in order to become familiar with these novel techniques that could reduce the burdens on healthcare systems.

Keywords: biofilm; infection prevention; new strategies; periprosthetic joint infection; unconventional treatment.

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Conflict of interest statement

The authors declare no conflicts of interes.

Figures

Figure 1
Figure 1
Stages of biofilm formation and anti-biofilm strategies.
Figure 2
Figure 2
X-rays of a right knee with an infected total knee arthroplasty showing cement beads inside the joint capsule.
Figure 3
Figure 3
Clinical image of a medial parapatellar arthrotomy with prior injection of methylene blue into the knee joint. Notice the more pronounced staining in areas where there is more compromised tissue.
Figure 4
Figure 4
Cement bead with xylitol and silver nitrate. Note the presence of multiple micropores due to xylitol, which significantly increases the elution of substances contained in the cement.
Figure 5
Figure 5
(A): An example of the use of CS with hydroxyapatite for PJI. (B): The beads are placed under the fascia, above the prosthesis or the spacer.
Figure 6
Figure 6
An example of using CS with hydroxyapatite (CERAMENT®) during the second stage of hip PJI revision. The uncemented stem is coated with CERAMENT® prior to reimplantation.
See this image and copyright information in PMC

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