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The Investigation and Management of Peri-Prosthetic Joint Infection After Total Knee Arthroplasty: An Update Based on
Sizar Doski1, Alexandra Sebastiao2, Prashant Thayaparan3
1Emergency Medicine, Imperial College Healthcare NHS Trust, London, GBR.
Insights
Early identification and management of peri-prosthetic joint infection (PJI) after total knee arthroplasty (TKA) are crucial. Adhering to British Orthopaedic Association guidelines and using a multidisciplinary team approach ensures optimal patient outcomes.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
Background:
- Peri-prosthetic joint infection (PJI) is a serious complication of total knee arthroplasty (TKA).
- PJI can lead to significant morbidity, including multiple surgeries, disability, and increased mortality.
- Prompt diagnosis and management are vital to mitigate these severe consequences.
Purpose of the Study:
- To provide an updated guideline on the early identification and management of PJI in TKA.
- To incorporate the latest British Orthopaedic Association (BOA) standards.
- To emphasize the importance of a multidisciplinary team (MDT) approach.
Main Methods:
- Review of clinical signs, inflammatory markers, imaging, and laboratory analyses for PJI diagnosis.
- Evaluation of management strategies including debridement antibiotics and implant retention (DAIR) and staged arthroplasty.
- Integration of updated BOA standards and guidelines.
Main Results:
- Diagnosis requires a comprehensive approach including clinical assessment, biomarkers, imaging, and synovial fluid analysis.
- Management options range from DAIR to single- or two-stage exchange arthroplasty.
- Adherence to BOA guidelines and MDT collaboration are key.
Conclusions:
- Early and accurate diagnosis of PJI in TKA is essential.
- Implementing updated BOA guidelines and fostering an MDT approach are critical for improving patient outcomes.
- Effective management strategies must be tailored to individual patient cases.
Abstract:
Peri-prosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA). Early identification and management are essential to prevent severe morbidity and mortality in these patients. Long-term complications of PJI include the need for multiple operations, disability, joint stiffness, reduced range of motion, and increased mortality. Clinical signs, inflammatory markers, imaging, tissue sampling, and synovial fluid analysis are required to diagnose PJI. Debridement antibiotics and implant retention (DAIR) is an effective management option, but single- or two-stage exchange arthroplasty may be ultimately required. All cases of PJI in TKA must be discussed in a multi-disciplinary (MDT) meeting. This review incorporates the updated British Orthopaedic Association (BOA) standard and speciality standard to provide an up-to-date guideline on the early identification and management of PJI. We highlight that adhering to the BOA guidelines and adopting an MDT approach are essential for optimal patient outcomes.
