Periprosthetic joint infection after arthroplasty: advances and future prospects

To comprehensively analyze the prevention, diagnosis and management strategies of periprosthetic joint infections(PJIs), provide new ideas for overcoming PJI, and provide references for clinicians.

By synthesizing the latest research results at home and abroad, this study deeply analyzed the multidimensional prevention strategies, diagnostic criteria and technological advances, and treatment management strategies for PJI.

The management of PJI remains a significant challenge in orthopedic surgery, which warrants focused attention. The prevention of PJI holds paramount priority and should be integrated throughout the perioperative period. Although diagnostic criteria for PJI have undergone multiple updates, the 2011 MSIS criteria remain the most widely adopted, requiring comprehensive evaluation of laboratory, pathological, and imaging examinations for diagnosis. PJI treatment necessitates combined antibiotic and surgical interventions. Antibiotic therapy includes empirical treatment after diagnosis, targeted therapy following pathogen identification, and suppressive antibiotic therapy(SAT) for non-surgical candidates. Surgical options comprise debridement, antibiotics, and implant retention(DAIR), one-stage/two-stage revision, and salvage procedures.

Implementation of standardized infection prevention protocols, rational antibiotic use, surgical technical innovations, and advancements in biomaterials have contributed to a reduction in PJI incidence. However, the spread of bacterial resistance and multidrug-resistant organisms in healthcare settings pose new challenges for PJI prevention and treatment. In the future, the research and development of new antimicrobial materials, the innovation of biofilm control technology and the application of precision medicine are expected to further reduce the incidence of PJI, improve the quality of life of patients, and promote a breakthrough in the field of arthroplasty regarding this issue.