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Updated: Jun 28, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
The Microbial Revolution in the World of Joint Replacement Surgery
Arjuna Srikrishnaraj1, Brent A Lanting1,2, Jeremy P Burton1,2
1Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Background:
The prevalence of revision surgery due to aseptic loosening and periprosthetic joint infection (PJI) following total hip and knee arthroplasty is growing. Strategies to prevent the need for revision surgery and its associated health-care costs and patient morbidity are needed. Therapies that modulate the gut microbiota to influence bone health and systemic inflammation are a novel area of research.
Methods:
A literature review of preclinical and clinical peer-reviewed articles relating to the role of the gut microbiota in bone health and PJI was performed.
Results:
There is evidence that the gut microbiota plays a role in maintaining bone mineral density, which can contribute to osseointegration, osteolysis, aseptic loosening, and periprosthetic fractures. Similarly, the gut microbiota influences gut permeability and the potential for bacterial translocation to the bloodstream, increasing susceptibility to PJI.
Conclusions:
Emerging evidence supports the role of the gut microbiota in the development of complications such as aseptic loosening and PJI after total hip or knee arthroplasty. There is a potential for microbial therapies such as probiotics or fecal microbial transplantation to moderate the risk of developing these complications. However, further investigation is required.
Clinical Relevance:
Modulation of the gut microbiota may influence patient outcomes following total joint arthroplasty.
Insights
The gut microbiota influences bone health and infection risk after joint replacement surgery. Modulating gut bacteria may offer new strategies to prevent complications like aseptic loosening and periprosthetic joint infection.
Area of Science:
- Orthopedic surgery
- Microbiome research
- Immunology
Background:
- Revision surgery rates for aseptic loosening and periprosthetic joint infection (PJI) after hip and knee arthroplasty are increasing.
- Novel strategies are needed to prevent revision surgery, reduce healthcare costs, and improve patient outcomes.
- Modulating the gut microbiota is an emerging area of research for influencing bone health and systemic inflammation.
Purpose of the Study:
- To review the role of the gut microbiota in bone health and PJI following total joint arthroplasty.
- To explore the potential of gut microbiota modulation as a therapeutic strategy.
Main Methods:
- A literature review of preclinical and clinical studies was conducted.
- Articles focused on the gut microbiota's impact on bone health and PJI were analyzed.
Main Results:
- The gut microbiota affects bone mineral density, influencing osseointegration, osteolysis, aseptic loosening, and fractures.
- Gut microbiota impacts gut permeability and bacterial translocation, increasing PJI susceptibility.
Conclusions:
- Emerging evidence links gut microbiota to aseptic loosening and PJI after total joint arthroplasty.
- Microbial therapies like probiotics and fecal microbiota transplantation show potential for risk moderation.
- Further research is necessary to validate these findings and therapeutic approaches.
