The Expanding Horizon of Prosthetic Joint Infections

Prosthetic joint infection (PJI) is a serious and potentially devastating complication of arthroplasty. Prior arthroplasty, immunosuppression, severe comorbid conditions, and prolonged surgical duration are important risk factors for PJI. More than half of the cases of PJI are caused by Staphylococcus aureus and coagulase-negative staphylococci. The biofilm plays a central role in its pathogenesis. The diagnosis of PJI requires the presence of purulence, sinus tract, evidence of inflammation on histopathology, or positive microbiologic cultures. The use of diagnostic imaging techniques is generally limited but may be helpful in selected cases. The most effective way to prevent PJI is to optimize the health of patients, using antibiotic prophylaxis in a proper and timely fashion. Management of PJI frequently requires removal of all hardware and administration of intravenous antibiotics. This review summarizes and analyzes the results of previous reports of PJI and assesses the prevention and management of this important entity.