Periprosthetic joint infection occurs in 1 to 2 percent of joint replacement surgeries and is one of the leading causes of arthroplasty failure [1-3]. The issues relating to the medical and surgical treatment 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 apply .
Biofilms play an important role in the pathogenesis of PJIs. Organisms within biofilm become resistant to therapy; as a result, antimicrobial therapy is often unsuccessful unless the biofilm is physically disrupted or removed by surgical debridement. Biofilms also account for two other features of PJIs: the propensity of infection to become apparent weeks or months after surgery, and the common observation that antimicrobial therapy results in a clinical response that is typically followed by a relapse within days or months if the infected prosthesis is retained. (See "Clinical manifestations and diagnosis of prosthetic joint infections", section on 'Biofilm'.)
The pathogenesis, clinical manifestations, and prevention of these infections are discussed separately. (See "Clinical manifestations and diagnosis of prosthetic joint infections" and "Epidemiology and prevention of prosthetic joint infections".)
TIMING OF INFECTION
Prosthetic joint infections (PJIs) are categorized according to the timing of symptom onset after implantation: early-onset (<3 months after surgery), delayed-onset (from 3 to 12 months after surgery), and late-onset (>12 months after surgery). These infections have the following characteristics :
●Early-onset infections are usually acquired during implantation and are often due to virulent organisms, such as S. aureus, gram-negative bacilli, anaerobic organisms, or mixed infections [1,4].