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Clinical manifestations and diagnosis of prosthetic joint infections

Elie Berbari, MD, FIDSA
Larry M Baddour, MD, FIDSA
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


The epidemiology, clinical manifestations, microbiology, and diagnosis of prosthetic joint infections (PJIs) will be reviewed here. Infections associated with other implanted orthopedic devices, such as pins and rods, will not be specifically discussed, but similar principles may apply [1].

Treatment and prevention of PJIs are discussed separately. (See "Treatment of prosthetic joint infections" and "Epidemiology and prevention of prosthetic joint infections".)


Nearly one million total hip arthroplasties (THAs) or total knee arthroplasties (TKAs) are performed in the United States each year. It is estimated that, by 2030, more than four million THAs or TKAs will be performed in the United States annually [2].

The rate of prosthetic joint infection (PJI) in most centers ranges between 0.5 to 1.0 percent for hip replacements, 0.5 to 2 percent for knee replacements, and less than 1 percent for shoulder replacements [1,3-5]. In a study involving over 69,000 patients undergoing elective total knee arthroplasty followed longitudinally from 1997 to 2006, the rate of infection was highest during the first two years following surgery (incidence 1.5 percent). The rate of infection 2 to 10 years after joint replacement was 0.5 percent [6]. Depending on the type of surgical procedure, causative pathogen, and comorbid conditions, upwards of 10 to 20 percent of patients experience recurrent PJI [7,8].

Risk factors — In a retrospective study evaluating 462 cases of prosthetic hip or knee infection, the major risk factor associated with infection was superficial surgical site infection (odds ratio [OR] 35.9). Other risk factors included presence of systemic or joint malignancy (OR 3.1), prior joint arthroplasty (OR 2.0) [4], or National Nosocomial Infections Surveillance System surgical patient risk index score of 1 or 2 (OR 1.7 and 3.9, respectively). In a meta-analysis of 66 observational studies and more than 500,000 patients, male gender and tobacco use were associated with an increased risk of PJI (relative risk [RR] 1.36; 95% CI 1.18-1.57 and RR 1.83; 95% CI 1.24-2.70, respectively) [9].


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Literature review current through: Sep 2016. | This topic last updated: Sep 29, 2016.
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