[Guidelines on antimicrobial therapy in situations of periprosthetic THR infection]

Area of Science:

• Orthopedics
• Infectious Diseases
• Biomaterials Science

Context:

• Periprosthetic joint infection (PJI) is a significant complication following artificial joint replacement surgery.
• PJIs are foreign body-associated infections of bone tissue, posing treatment challenges with conventional antimicrobial agents.
• Early, non-established infections may differ in management from established PJIs.

Purpose:

• To outline the current understanding and management strategies for periprosthetic joint infections.
• To emphasize the necessity of surgical intervention and antimicrobial therapy in PJI treatment.
• To highlight the need for specialized centers and experienced multidisciplinary teams for optimal PJI management.

Summary:

• Surgical removal of infected prostheses and thorough debridement of bone and soft tissue are critical for treating periprosthetic joint infections.
• Treatment options include one or two-stage prosthesis exchange, prosthesis removal with pseudoarthroplasty or arthrodesis, and in rare cases, amputation.
• All surgical interventions are complemented by systemic and/or topical antimicrobial therapy, with drug delivery systems playing a role.

Impact:

• Effective management of periprosthetic joint infections requires a coordinated approach involving experienced surgical teams and infectious disease specialists.
• The complexity of PJI treatment necessitates that these infections be managed exclusively in specialized centers of competence.
• Further controlled studies are needed to compare the efficacy of different surgical revision strategies, such as one-stage versus two-stage exchange procedures.