Periprosthetic Joint Infection
The Unending Journey
Keywords:
Aetiopathogenesis, epidemiology, management, periprosthetic joint infection, prevention, reviewAbstract
Periprosthetic joint infection (PJI) is one disaster too many and will remain a never‑ending topic as long as joints are replaced all over the world. The objective was to review current literatures on the pathology, management and prevention of PJI. This is a descriptive review of the current literatures on the definition, epidemiology, risk factors, pathology, classification, diagnosis, treatment and prevention of PJI. PJI is one of the most common causes of revision arthroplasty with increasing incidence. The risk factors are patient, staff and environmental mediated, and they are grouped into modifiable and non‑modifiable risk factors. The modifiable risk factors are controllable. In general, PJI can be early or late, and this provides a guide to treatment. Arriving at a diagnosis can be clinical, laboratory, radiological or a combination, with newer trends geared towards identifying the exact organism causing the infection. Preventing PJI is the goal of every arthroplasty surgeon. The diagnosis of PJI remains a problem, and the optimal method of treatment is a subject of debate. Therefore, preventive measures should be topmost on every surgeon’s mind.
References
1. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensuson periprosthetic joint infection. Bone Joint J 2013;95‑B:1450‑2.
2. Parvizi J, Zmistowski B, Berbari EF, Bauer TW,Springer BD, Della Valle CJ, et al. New definition for periprostheticjoint infection: From the Workgroup of the Musculoskeletal InfectionSociety. Clin Orthop Relat Res 2011;469:2992‑4.
3. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF,et al. The 2018 definition of periprosthetic hip and knee infection: Anevidence‑based and validated criteria. J Arthroplasty 2018;33:1309‑400.
4. Peersman G, Laskin R, Davis J, Peterson M. Infection in total kneereplacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 2001;392:15-23.
5. Blom AW, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total hip arthroplasty. The Avon experience. J Bone JointSurg Br 2003;85:956‑9.
6. Gbejuade HO, Lovering AM, Webb JC. The role of microbial biofilmsin prosthetic joint infections. Acta Orthop 2015;86:147‑58.
7. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiologyof revision total hip arthroplasty in the United States. J Bone Joint SurgAm 2009;91:128‑33.
8. Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, et al. Future clinical and economic impact of revision total hip and kneearthroplasty. J Bone Joint Surg Am 2007;89 Suppl 3:144‑51.
9. George DA, Drago L, Scarponi S, Gallazzi E, Haddad FS, Romano CL. Predicting lower limb periprosthetic joint infections: A review of riskfactors and their classification. World J Orthop 2017;8:400‑11.
10. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev2014;27:302‑45.
11. Langvatn H, Lutro O, Dale H, Schrama JC, Hallan G, Espehaug B, et al. Bacterial and haematological findings in infected total hip arthroplastyin Norway assessment of 278 revisions due to infection in the Norwegianarthroplasty register. Open Orthop J 2015;9:445‑9.
12. Della Valle C, Parvizi J, Bauer TW, DiCesare PE, Evans RP, Segreti J,et al. American Academy of Orthopaedic Surgeons clinical practiceguideline on: The diagnosis of periprosthetic joint infections of the hipand knee. J Bone Joint Surg Am 2011;93:1355‑7.
13. Tornero E, Senneville E, Euba G, Petersdorf S, Rodriguez‑Pardo D,Lakatos B, et al. Characteristics of prosthetic joint infections due toEnterococcus sp. and predictors of failure: A multi‑national study. ClinMicrobiol Infect 2014;20:1219‑24.
14. Lam A, Rasmussen M, Thompson O. Successful outcome for patientswith streptococcal prosthetic joint infections – A retrospectivepopulation‑based study. Infect Dis (Lond) 2018;50:593‑600.
15. Rodríguez‑Pardo D, Pigrau C, Lora‑Tamayo J, Soriano A, del Toro MD,Cobo J, et al. Gram‑negative prosthetic joint infection: Outcome ofa debridement, antibiotics and implant retention approach. A largemulticentre study. Clin Microbiol Infect 2014;20:911‑9.
16. Murillo O, Grau I, Lora‑Tamayo J, Gomez‑Junyent J, Ribera A,Tubau F, et al. The changing epidemiology of bacteraemic osteoarticularinfections in the early 21st century. Clin Microbiol Infect 2015;21:254.e1‑8.
17. Fernandes A, Dias M. The microbiological profiles of infected prostheticimplants with an emphasis on the organisms which form biofilms. J ClinDiagn Res 2013;7:219‑23.
18. Shah NB, Tande AJ, Patel R, Berbari EF. Anaerobic prosthetic jointinfection. Anaerobe 2015;36:1‑8.
19. Cazanave C, Greenwood‑Quaintance KE, Hanssen AD, Patel R. Corynebacterium prosthetic joint infection. J Clin Microbiol2012;50:1518‑23.
20. Dutronc H, Dauchy FA, Cazanave C, Rougie C, Lafarie‑Castet S,Couprie B, et al. Candida prosthetic infections: Case series and literature review. Scand J Infect Dis 2010;42:890‑5.
21. Bartalesi F, Fallani S, Salomoni E, Marcucci M, Meli M, Pecile P, et al. Candida glabrata prosthetic hip infection. Am J Orthop (Belle Mead NJ)2012;41:500‑5.
22. Yoon HK, Cho SH, Lee DY, Kang BH, Lee SH, Moon DG, et al. A review of the literature on culture‑negative periprosthetic jointinfection: Epidemiology, diagnosis and treatment. Knee Surg Relat Res2017;29:155‑64.
23. Parvizi J, Erkocak OF, Della Valle CJ. Culture‑negative periprostheticjoint infection. J Bone Joint Surg Am 2014;96:430‑6.
24. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection:Current concepts and outlook. EFORT Open Rev 2019;4:482‑94.
25. Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A,Bedair H, et al. Diagnosis of periprosthetic joint infection. J Arthroplasty2014;29:77‑83.
26. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic joint infections. N E JMed 2004;351:1701‑3.
27. Trampuz A, Zimmerli W. Prosthetic joint infections: Update in diagnosisand treatment. Swiss Med Wkly 2005;135:243‑51.
28. Trebse R. Stalc J. Pathogenesis of Prosthetic Joint Infections. In:Trebse R. (eds) Infected Total Joint Arthroplasty. Springer-Verlag:London; 2012; 95-101.
29. Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am 1975;6:991‑1003.
30. Fitzgerald RH Jr. Infected total hip arthroplasty: Diagnosis andtreatment. J Am Acad Orthop Surg 1995;3:249‑62.
31. Lee HD, Prashant K, Shon WY. Management of periprosthetic hip jointinfection. Hip Pelvis 2015;27:63‑71.
32. Bonanzinga T, Tanzi P, Lacono F, Ferrari MC, Marcacci M. Periprosthetic knee infection: Two stage revision surgery. Acta Biomed2017;88 Suppl 4:114‑9.
33. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hiparthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996;78:512‑23.
34. Anagnostakos K, Schmid NV, Kelm J, Grün U, Jung J. Classification ofhip joint infections. Int J Med Sci 2009;6:227‑33.
35. McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection. Outcomes using a staging system. ClinOrthop Relat Res 2002;403:8-15.
36. Peel TN, Buisng KL, Choong PF. Diagnosis and management ofprosthetic joint infection. Curr Opin Infec Disc 2012;25:670‑6.
37. Springer BD. The diagnosis of periprosthetic joint infection. J Arthroplasty 2015;30:908‑11.
38. Shahi A, Parvizi J. The role of biomarkers in the diagnosis ofperiprosthetic joint infection. EFORT Open Rev 2016;1:275‑8.
39. Parvizi J, Della Valle CJ. AAOS Clinical Practice Guideline: Diagnosisand treatment of periprosthetic joint infections of the hip and knee. J AmAcad Orthop Surg 2010;18:771‑2.
40. Bingham J, Clarke H, Spangehl M, Schwartz A, Beauchamp C,Goldberg B. The alpha defensin‑1 biomarker assay can be used toevaluate the potentially infected total joint arthroplasty. Clin OrthopRelat Res 2014;472:4006‑9.
41. Gehrke T, Parvizi J. Proceedings of the International Consensus Meetingon Periprosthetic Joint Infection. J Arthroplasty 2014;29:1‑4.
42. Wang C, Wang Q, Li R, Duan JY, Wang CB. Synovial fluidC‑reactive protein as a diagnostic marker for periprosthetic jointinfection: A systematic review and meta‑analysis. Chin Med J (Engl)2016;129:1987‑93.
43. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W,Steckelberg JM, et al. Diagnosis and management of prosthetic jointinfection: Clinical Practice Guidelines by the Infectious DiseasesSociety of America. Clin Infect Dis 2013;56:E1‑25.
44. Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy‑Smith P,et al. One hundred and twelve infected arthroplasties treated with‘DAIR’ (debridement, antibiotics and implant retention): Antibioticduration and outcome. J Antimicrob Chemother 2009;63:1264‑71.
45. Buchholz HW, Elson RA, Engelbrecht E, Lodenkämper H, RöttgerJ, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br 1981;63‑B:342‑53.
46. Thakrar RR, Horriat S, Kayani B, Haddad FS. Indications for asingle‑stage exchange arthroplasty for chronic prosthetic joint infection:A systematic review. Bone Joint J 2019;101‑B:19‑24.
47. Jackson WO, Schmalzried TP. Limited role of direct exchangearthroplasty in the treatment of infected total hip replacements. Clinorthop Relat Res 2000;381:101-6.
48. Rowan FE, Donaldson MJ, Pietrzak JR, Haddad FS. The role of one‑stageexchange for prosthetic joint infection. Curr Rev Musculoskelet Med2018;11:370‑9.
49. Ilchmann T, Zimmerli W, Ochsner PE, Kessler B, Zwicky L, Graber P,et al. One‑stage revision of infected hip arthroplasty: Outcome of 39consecutive hips. Int Orthop 2016;40:913‑8.
50. Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD;Inform Team. Re‑infection outcomes following one‑ and two‑stagesurgical revision of infected knee prosthesis: A systematic review andmeta‑analysis. PLoS One 2016;11:e0151537.
51. Insall JN, Thompson FM, Brause BD. Two‑stage reimplantation forthe salvage of infected total knee arthroplasty. J Bone Joint Surg Am1983;65:1087‑98.
52. Lu J, Han J, Zhang C, Yang Y, Yao Z. Infection after total kneearthroplasty and its gold standard surgical treatment: Spacers used intwo‑stage revision arthroplasty. Intractable Rare Dis Res 2017;6:256‑61.
53. Charette RS, Melnic CM. Two‑stage revision arthroplasty for thetreatment of prosthetic joint infection. Curr Rev Musculoskelet Med2018;11:332‑40.
54. Vadiee I, Backstein DJ. The effectiveness of repeat two‑stage revisionfor the treatment of recalcitrant total knee arthroplasty infection. J Arthroplasty 2019;34:369‑74.
55. Romanò CL, Gala L, Logoluso N, Romanò D, Drago L. Two‑stagerevision of septic knee prosthesis with articulating knee spacersyields better infection eradication rate than one‑stage or two‑stagerevision with static spacers. Knee Surg Sports Traumatol Arthrosc2012;20:2445‑53.
56. Durbhakula SM, Czajka J, Fuchs MD, Uhl RL. Spacer endoprosthesisor the treatment of infected total hip arthroplasty. J Arthroplasty2004;19:760‑7.
57. Chen SY, Hu CC, Chen CC, Chang YH, Hsieh PH. Two-stage revisionarthroplasty for periprosthetic hip infection: mean follow-up of tenyears. BioMed Research International. 2015:7. Article ID 345475.doi:10.1155/2015/345475.
58. Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D. Two‑stage revision arthroplasty for management of chronicperiprosthetic hip and knee infection: Techniques, controversies, andoutcomes. J Am Acad Orthop Surg 2014;22:153‑64.
59. Parvizi J, Azzam K, Ghanem E, Austin MS, Rothman RH. Periprostheticinfection due to resistant staphylococci: Serious problems on thehorizon. Clin Orthop Relat Res 2009;467:1732‑9.
60. Oussedik SI, Dodd MB, Haddad FS. Outcomes of revision total hipreplacement for infection after grading according to a standard protocol. J Bone Joint Surg Br 2010;92:1222‑6.
61. McLawhorn AS, Nawabi DH, Ranawat AS. Management of resistant,atypical and culture‑negative periprosthetic joint infections after hip andknee arthroplasty. Open Orthop J 2016;10:615‑32.
62. Bejon P, Berendt A, Atkins BL, Green N, Parry H, Masters S, et al. Two‑stage revision for prosthetic joint infection: Predictors of outcomeand the role of reimplantation microbiology. J Antimicrob Chemother2010;65:569‑75.
63. Veltman ES, Moojen DJF, van Ogtrop ML, Poolman RW. Two‑stagerevision arthroplasty for coagulase‑negative staphylococcalperiprosthetic joint infection of the hip and knee. World J Orthop2019;10:348‑55.
64. Potter GD, Rao N, Mabry TM. Prevention of periprosthetic jointinfection. In: Springer BD, Parvizi J, editors. Periprosthetic JointInfection of the Hip and Knee. New York: Springer Science+BusinessMedia; 2014. p. 41‑51.
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