Prosthetic Joint Infection

Javier Cobo; Jose Luis Del Pozo


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

In This Article

Expert Commentary & Five-year View

The projected increase of PJI will impact the workload and resources of the orthopedic services in the coming years. Multidisciplinary specialized teams will be essential in order to optimize these patients' care.

Prosthetic joint infections represent an extraordinary challenge for the investigators and physicians who treat these diseases. All the aspects related to its management raise questions not yet resolved. Regarding diagnosis, we need to know if it is feasible to diagnose 'late chronic' infections earlier. These infections are acquired (almost certainly) during surgery. If we were able to detect them earlier, we could possibly avoid implant removal. A closer follow-up of patients based on serum markers or, even on a scheduled analysis of synovial fluid in selected patients, could help us to attain this goal. In the coming years, we should also be able to determine the true role of new molecular microbiological tools and the usefulness of implant sonication. These techniques could also improve our knowledge of the microbiology of these infections. Confirmation of a polyclonal or polimicrobial etiology in chronic infections would have an impact on the antimicrobial therapy.

During the coming years, it will be crucial to establish a wide consensus on classification, terminology and PJI stage in order to contrast series and algorithms of management.

Regarding therapy, the actual challenge lies in the design and validation of algorithms for the management of patients diagnosed with PJIs. We should analyze not only microbiological cure, but also functional results and quality of life, using different strategies for different scenarios. Large multicenter databases are, clearly, necessary for this purpose. Details regarding the optimal antimicrobial therapy remain fully open. By selecting specific scenarios with homogeneous surgical approaches, it would be possible to design clinical trials focusing on concrete aspects (i.e., the duration of therapy, the role of new antibacterials or the appropriateness of one-stage prosthesis exchange). Nevertheless, hundred of patients should be recruited and it only could be achieved in large multicenter studies. Meanwhile, large databases containing qualified data should help us to deal with these questions.

On a more long-term scale, the exploration of novel antibiofilm therapies would impact both prevention and treatment of PJI.