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Periprosthetic joint infection: treatment options
Javad Parvizi1, Benjamin Zmistowski, Bahar Adeli
1Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA. parvj@aol.com
Orthopedics
|September 16, 2010
Summary
Periprosthetic joint infection (PJI) treatment for total knee arthroplasty failure has evolved. Two-stage revision with an antibiotic spacer is the gold standard for PJI eradication, balancing success and function.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic joint infection (PJI) is the leading cause of total knee arthroplasty failure.
- Treatment strategies have advanced with technology and pathogen understanding over four decades.
Purpose of the Study:
- To review the evolving treatment landscape for periprosthetic joint infection (PJI) after total knee arthroplasty.
- To outline current treatment selection criteria based on patient factors and infection characteristics.
Main Methods:
- Review of treatment modalities including antibiotic suppression, irrigation and debridement with component exchange, and single-stage vs. two-stage revision.
- Discussion of salvage procedures like arthrodesis and amputation for uncontrollable infections.
Main Results:
- Two-stage revision with an antibiotic-loaded spacer is the current gold standard for PJI eradication.
- Irrigation and debridement with component exchange offers component retention for acute infections.
- Salvage procedures are necessary for immunocompromised patients with uncontrollable PJI.
Conclusions:
- Treatment selection for PJI depends on patient immunity, symptom onset, and pathogen profile.
- Two-stage revision provides the highest success rate for PJI eradication.
- Salvage options like amputation may be required for severe, refractory cases.
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