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Diagnosis uses consensus criteria (MSIS/ICM) combining major and minor criteria. Classify by timing: early (<3 mo), delayed (3–24 mo), late (>24 mo) — guides biofilm maturity and strategy. Treatment options: DAIR (debridement, antibiotics, implant retention), one‑stage or two‑stage revision; chronic suppression in poor hosts. Principles: radical debridement, exchange modular parts, biofilm‑active antibiotics (e.g., rifampicin combinations for staph). Prevention bundle: laminar flow, antibiotic prophylaxis, skin prep, glycemic control, normothermia.
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Periprosthetic joint infection (PJI) is one of the most serious complications following joint replacement surgery. It occurs when microorganisms colonize the tissues surrounding a prosthetic joint implant, leading to inflammation, implant loosening, and joint dysfunction. PJI is most commonly associated with total hip arthroplasty and total knee arthroplasty.
The incidence of PJI after primary joint replacement is approximately one to two percent, but the consequences can be devastating for patients. Infection may lead to prolonged hospitalization, multiple surgeries, functional impairment, and significant healthcare costs.
Management of periprosthetic joint infection requires a multidisciplinary approach involving orthopaedic surgeons, infectious disease specialists, microbiologists, and rehabilitation teams. Early diagnosis and appropriate treatment strategies are essential for successful outcomes.
Periprosthetic joint infections occur when microorganisms adhere to the surface of an implant and form a biofilm. Biofilm formation allows bacteria to survive within a protective matrix that shields them from host immune responses and antibiotics.
The most common organisms responsible for PJI are Gram positive bacteria, particularly Staphylococcus species.
| Organism | Clinical Association |
|---|---|
| Staphylococcus aureus | Acute postoperative infections |
| Staphylococcus epidermidis | Chronic low grade infections |
| Streptococcus species | Hematogenous infections |
| Gram negative bacteria | Immunocompromised patients |
Biofilm formation on implant surfaces significantly complicates treatment because bacteria embedded in biofilms exhibit resistance to antibiotics and immune defense mechanisms.
Periprosthetic joint infection can occur through several routes depending on the timing and mechanism of bacterial entry.
Intraoperative contamination is believed to be responsible for most early infections following arthroplasty procedures.
Periprosthetic joint infections are commonly classified according to the time of onset following surgery.
| Type | Time of Onset | Typical Features |
|---|---|---|
| Early infection | Within 3 months | Acute pain, wound drainage, erythema |
| Delayed infection | 3 to 24 months | Persistent joint pain and loosening |
| Late infection | More than 24 months | Hematogenous infection |
Several patient related and procedure related factors increase the risk of periprosthetic joint infection.
Optimization of these factors prior to surgery can significantly reduce infection risk.
Clinical presentation depends on the timing and severity of infection.
A sinus tract communicating with the prosthetic joint is considered diagnostic of periprosthetic joint infection.
Diagnosis of periprosthetic joint infection requires integration of clinical findings, laboratory tests and imaging studies.
Synovial fluid leukocyte count and neutrophil percentage are particularly useful diagnostic markers.
Management of periprosthetic joint infection depends on the chronicity of infection, organism involved, and stability of the prosthesis.
| Treatment Method | Indication |
|---|---|
| Debridement with implant retention | Early infections with stable implant |
| One stage revision | Selected chronic infections |
| Two stage revision | Gold standard for chronic infection |
| Resection arthroplasty | Severe infection or poor host factors |
Two stage revision arthroplasty remains the most commonly used method for treating chronic periprosthetic joint infections.
Prevention of periprosthetic joint infection is a critical aspect of joint replacement surgery.
These measures significantly reduce infection rates following arthroplasty procedures.
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