Diagnosis and Prevention of Periprosthetic Joint Infections

Creighton C. Tubb, MD; Gregory G. Polkowksi, MD; Barbara Krause


J Am Acad Orthop Surg. 2020;28(8):e340-e348. 

In This Article

Abstract and Introduction


The Diagnosis and Prevention of Periprosthetic Joint Infections Clinical Practice Guideline is based on a systematic review of current scientific and clinical research. Through analysis of the current best evidence, this guideline seeks to evaluate strategies to mitigate the risk of periprosthetic joint infection (PJI) in hip and knee arthroplasty and identify best practices in the diagnostic evaluation for these infections. Twenty-five recommendations related to prevention and diagnosis of PJI are presented. In addition, the work group highlighted areas for needed additional research when evidence proved lacking on the topic and carefully reviewed the rationale behind the recommendations while also noting potential harms or risks associated with implementation.


The American Academy of Orthopaedic Surgeons (AAOS), with input from representatives from the American Association of Hip and Knee Surgeons, the American Society for Clinical Pathology, the American Society for Microbiology, the Infectious Disease Society of America, The Hip Society, The Knee Society, the Society of Nuclear Medicine and Molecular Imaging, the College of American Pathologists, and the American College of Radiology, recently published their clinical practice guideline (CPG), Diagnosis and Prevention of Periprosthetic Joint Infections (PJI).[1] This CPG was approved by the AAOS Board of Directors in March, 2019. The purpose of this CPG is to provide recommendations for preventive strategies and diagnostic tools for PJI based on current best evidence.

With the aging cohort and continued advancement in joint arthroplasty, the demand for hip and knee replacement is expected to continue to rise.[2,3] With the demand for these surgeries is also an expectation for an increased prevalence of periprosthetic joint infection requiring revision surgery.[4]

Defining the incidence and prevalence of PJI has been difficult with unclear definitions for diagnosis of PJI in the literature until recently.[5,6] The reported prevalence of PJI out to 2 years after hip replacement is 1.63%[7] and after knee replacement is 1.55%.[8] Both procedures likely have a prevalence over 2% at 10 years.[7,8]

PJI for the individual patient is devastating with increased rate of mortality,[9] increased risk of morbidity,[10] decreased quality of life,[11] and potential for decreased level of mobility and ambulation.[12]

In addition, the economic burden (represented by hospital costs) of periprosthetic joint infection in the United States is estimated at an annual cost of $1.62 billion (confidence interval $1.53 to 1.72 billion) in 2020.[13] These data did not include the cost of surgeon or other provider services nor the postacute care or patient's lost work productivity, making the societal costs for PJI remarkably high.