Periprosthetic joint infection: current concepts and outlook

Overview

This 2019 review in EFORT Open Reviews by Izakovicova, Borens and Trampuz summarises current concepts in managing periprosthetic joint infection (PJI) after joint arthroplasty. It presents PJI as a biofilm-driven complication that calls for coordinated work between orthopaedic and plastic surgeons, infectious disease physicians and microbiologists.

Who it is for

Orthopaedic and trauma surgeons, infectious disease specialists, microbiologists and residents who assess painful or failing joint replacements and plan revision surgery.

Key areas covered

The review explains how infection reaches the implant, whether during surgery, through the bloodstream or from a neighbouring focus, and how microbial virulence shapes early versus delayed presentation. It describes why micro-organisms living as biofilm on implant surfaces resist both host defences and conventional antibiotics. It discusses newer working definitions intended to capture low-grade chronic infections, and a time-based classification linked to biofilm maturity. The diagnostic section weighs clinical signs, imaging, blood markers, synovial fluid analysis, intra-operative tissue sampling, implant sonication, molecular methods and histopathology, with particular weight on preoperative joint aspiration.

Notable emphasis

The authors set out a treatment algorithm that matches the surgical approach (debridement with implant retention, or one-, two- or multi-stage exchange) to infection chronicity, tissue condition and pathogen. They argue that one-stage exchange suits many patients with chronic infection and favourable local conditions, and that routine two-stage revision may overtreat a large share of cases. They also stress restricting biofilm-active agents to defined situations to limit resistance, and outline emerging directions such as implant coatings, local antibiotic carriers and bacteriophage therapy.

How to use this guideline

The article includes diagnostic and treatment algorithms and summary tables reproduced from the PRO-IMPLANT Foundation pocket guide. Readers should consult the full text for specific criteria and antimicrobial regimens and apply them within local protocols and multidisciplinary review.