Prosthetic joint infection: diagnosis and management

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Prosthetic joint implantations enhance quality of life but risk complications like aseptic failure and prosthetic joint infection (PJI).
• Biofilms are critical in persistent PJI, making late chronic infections difficult to diagnose.
• While early infections are often straightforward, predicting late-stage PJI remains a challenge.

Purpose of the Study:

• To review diagnostic and treatment strategies for prosthetic joint infection (PJI).
• To highlight the challenges in diagnosing chronic PJI and the role of biofilms.
• To outline key considerations for tailoring treatment to individual patient needs.

Main Methods:

• Review of current literature on prosthetic joint infection (PJI) diagnosis and management.
• Discussion of diagnostic tools including joint aspiration, differential cell counts, implant sonication, and molecular studies.
• Analysis of treatment objectives and factors influencing surgical and antimicrobial strategies.

Main Results:

• Joint aspiration with differential cell counts is a valuable diagnostic test for PJI.
• Novel microbiological techniques like implant sonication and molecular studies show promise for improved detection.
• Treatment success depends on eradicating infection, alleviating pain, and restoring function, guided by infection type, loosening, prognosis, and patient preferences.

Conclusions:

• Effective management of PJI requires a comprehensive approach integrating surgical strategy and antimicrobial therapy.
• Evidence in PJI management is limited, relying on case series, experimental data, and expert opinion.
• Personalized treatment plans are essential for optimizing outcomes in patients with prosthetic joint infection.