Diagnosis and Management of Prosthetic Joint Infection

Trisha N. Peel; Kirsty L. Buising; Peter F.M. Choong

Disclosures

Curr Opin Infect Dis. 2012;25(6):670-676. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Prosthetic joint infection remains a devastating complication of arthroplasty associated with significant patient morbidity. The demand for arthroplasty is rapidly growing with a corresponding increase in the number of infections involving the prosthesis. The diagnosis and treatment of prosthetic joint infections presents a significant challenge to orthopaedic and infectious diseases clinicians.

Recent findings The underlying pathogenesis of prosthetic joint infections is due to the ability of the microorganisms to form a biofilm. The biofilm provides protection against host immune responses and antimicrobial therapy. In addition, it impedes standard laboratory diagnostic techniques. This review will examine new investigations to improve the diagnostic yield and rapidity of diagnosis of infections, including the use of sonication to disrupt the biofilm, new molecular tests to improve the detection of infecting microorganisms and new imaging techniques such as 18F-fluoro-deoxyglucose PET.

Summary The successful treatment of prosthetic joint infections is dependent on eliminating the biofilm dwelling microorganisms whilst maintaining patient mobility and quality of life. This review will examine current understanding of management approaches for these infections, with a particular focus on antimicrobial therapy with activity against the biofilm, such as rifampicin and fluoroquinolones.

Introduction

Prosthetic joint surgery is a common surgical procedure that has led to remarkable improvements in a patient's quality of life. With an ageing population, the demand for surgery will increase significantly over the next 20 years.[1] Infection of the prosthesis is uncommon, occurring in 1–3% of patients; however, it is a devastating complication of this surgery.[2,3] In addition, the economic burden of managing these infections is substantial.[4–6]

The diagnosis and management of prosthetic joint infections (PJIs) is intimately reliant on an understanding of the underlying pathogenesis of these infections, in particular the role of biofilm formation by the infecting microorganisms. Timely diagnosis and optimal management of PJI is associated with reduced suffering for patients and improved outcomes. The aim of this review is to examine the current understanding of the pathogenesis, diagnostic and management approaches to PJI.

processing....