Frontiers in the Management of Orthopaedic Periprosthetic Joint Infection

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA).
• Current treatments like debridement, antibiotics, and implant retention (DAIR) for acute PJI have high failure rates, often due to antibiotic-tolerant biofilms.
• Chronic PJI management via two-stage revision involves significant morbidity during the interstage period.

Purpose of the Study:

• To review current and emerging strategies for preventing and managing periprosthetic joint infections.
• To highlight innovative technologies targeting biofilm formation and persistence.
• To explore novel salvage options for treatment failures.

Main Methods:

• Literature review of PJI management strategies.
• Analysis of preventative measures including patient optimization and local antiseptics.
• Evaluation of innovative treatments such as biofilm-active agents, advanced implant surfaces, and bacteriophage therapy.

Main Results:

• Preventative strategies encompass preoperative optimization, antibiotic prophylaxis, and local antimicrobial applications.
• Emerging innovations include targeted antibiotic delivery, advanced irrigation protocols, and one-stage revision techniques.
• Technologies to combat biofilms involve antibacterial surfaces, physical disruption methods, and novel therapies like bacteriophages.

Conclusions:

• Addressing biofilm is critical for improving PJI treatment outcomes.
• A combination of enhanced preventative measures and innovative therapeutic strategies is essential.
• Novel approaches like bacteriophage therapy offer promising future directions for salvage treatment.