Periprosthetic joint infection

• Published in: The Lancet (British edition) Vol. 387; no. 10016; pp. 386 - 394
• Main Authors: Kapadia, Bhaveen H, MD, Berg, Richard A, MD, Daley, Jacqueline A, BSc, Fritz, Jan, MD, Bhave, Anil, PT, Mont, Michael A, Director
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 23-01-2016; Elsevier Limited
• Subjects: Alcohol; Anti-Bacterial Agents - therapeutic use; Antibiotics; Anticoagulants; Arthroplasty, Replacement - adverse effects; Bacteria; Biofilms; Debridement; Decontamination; Diabetes; Drug resistance; Epidemiology; Humans; Infection Control; Internal Medicine; Joint Prosthesis - adverse effects; Joint surgery; Knee; Mortality; Obesity; Organisms; Patients; Perioperative Care; Prostheses; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - economics; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - therapy; Reoperation; Researchers; Risk assessment; Risk Factors; Royalties; Staphylococcus infections; Streptococcus infections; Substance abuse treatment; Surgery; Therapeutic Irrigation; Transplants & implants; United States > US
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(14)61798-0

Summary Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. More than 25% of revisions are attributed to these infections, which are expected to increase. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Recognition of the challenge of surgical site infections in general, and periprosthetic joint infections particularly, has prompted implementation of enhanced prevention measures preoperatively (glycaemic control, skin decontamination, decolonisation, etc), intraoperatively (ultraclean operative environment, blood conservation, etc), and postoperatively (refined anticoagulation, improved wound dressings, etc). Additionally, indications for surgical management have been refined. In this Review, we assess risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection. An international consensus meeting about such infections identified the best practices and further research needs. Orthopaedics could benefit from enhanced preventive, diagnostic, and treatment methods.