Prosthetic Joint Infection

Javier Cobo; Jose Luis Del Pozo


Expert Rev Anti Infect Ther. 2011;9(9):787-802. 

In This Article


The most commonly isolated microorganisms are Gram-positive cocci with coagulase-negative staphylococci, S. aureus and enterococci accounting for 65% of cases.[9] Aerobic Gram-negative bacilli, including Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa, are far less frequent causes of infection (6%). Anaerobes, including Propionibacterium acnes, account for 4% of infections.[10] Rare microbial causes of PJI have been reported (Figure 1 & Box 1, Box 2, Box 3).[11–15] Approximately 7% of patients with PJI have aerobic and anaerobic cultures of periprosthetic tissue samples without any growth (i.e., culture-negative PJI).[16] With the use of new microbiological techniques (i.e., implant sonication and culture, and molecular techniques), the proportion of culture-negative implant-associated infections may decrease in the future.

Figure 1.

Microbiology, pathogenesis and diagnosis of prosthetic joint associated infection. (1) Anteroposterior radiograph (AP-Rx) of a prosthetic shoulder; (2) AP-Rx of a prosthetic elbow; (3) AP-Rx of a prosthetic elbow; (4) AP-Rx of a spinal implant; (5) AP-Rx of a prosthetic metacarpophalangeal joint; (6) AP-Rx showing a prosthetic hip; (7) AP-Rx showing a total knee prosthesis; (8) AP-Rx showing a total ankle prosthesis; (9) AP-Rx showing a metatarsophalangeal joint prosthesis; (10) Detail of a porous coated acetabular component. Screws can be used for additional bony anchorage (note the holes on the surface); (11) Modern prosthetic knees consist of metal and ultrahigh molecular-weight and polyethylene plastic; (12) Detail of a shoulder prosthesis components (stem, adapter and head); (13) Staphylococcus epidermidis biofilm SEM image (3 k); (14) P. aeruginosa biofilm SEM image (3 k). PMN: Polymorphonuclear cell.