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Prosthetic Joint Infections: an Update

  • Skin, Soft Tissue, Bone and Joint Infectious Disease (N Safdar and A Pop-Vicas, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Prosthetic joint infection (PJI) is a rare but serious complication that is frequently misdiagnosed. We aimed to highlight the nuances of PJI diagnosis and antimicrobial therapies and provide clarity in key areas of management.

Recent Findings

Current research in PJI centers on a potential role for diagnostic biomarkers, molecular techniques, and implant sonication to reduce culture-negativity rates. The optimal duration of antimicrobial therapy remains controversial.

Summary

A high clinical index of suspicion for PJI combined with data from multiple preoperative and intraoperative tests enables timely diagnosis and treatment. Biomarkers, molecular methods, and implant sonication are currently adjunctive to traditional diagnostic techniques. Shorter courses of antimicrobial therapies as well as the role of chronic suppressive therapy need confirmation by randomized controlled trials. Existing practices for preoperative dental prophylaxis and treatment of asymptomatic bacteriuria warrant revision based on evidence arguing against risk for PJI.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350(14):1422–9. https://doi.org/10.1056/NEJMra035415.

    Article  PubMed  CAS  Google Scholar 

  2. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51. https://doi.org/10.1007/s11999-009-0945-0.

    Article  PubMed  Google Scholar 

  3. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128–33. https://doi.org/10.2106/jbjs.h.00155.

    Article  PubMed  Google Scholar 

  4. Barrack RL, Burnett RS, Sharkey P, Parvizi J. Diagnosing an infection: an unsolved problem. Orthopedics. 2007;30(9):777–8.

    PubMed  Google Scholar 

  5. Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am. 2006;88(4):869–82. https://doi.org/10.2106/jbjs.e.01149.

    Article  PubMed  Google Scholar 

  6. Della Valle C, Parvizi J, Bauer TW, Dicesare PE, Evans RP, Segreti J, et al. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18(12):760–70.

    Article  PubMed  Google Scholar 

  7. Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010;468(1):52–6. https://doi.org/10.1007/s11999-009-1013-5.

    Article  PubMed  Google Scholar 

  8. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplast. 2009;24(6 Suppl):105–9. https://doi.org/10.1016/j.arth.2009.04.027.

    Article  Google Scholar 

  9. Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics. 2010;33(9):659. https://doi.org/10.3928/01477447-20100722-42.

    Article  PubMed  Google Scholar 

  10. Senthi S, Munro JT, Pitto RP. Infection in total hip replacement: meta-analysis. Int Orthop. 2011;35(2):253–60. https://doi.org/10.1007/s00264-010-1144-z.

    Article  PubMed  Google Scholar 

  11. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplast. 2012;27(8 Suppl):61–5.e1. https://doi.org/10.1016/j.arth.2012.02.022.

    Article  Google Scholar 

  12. Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S, et al. Increasing risk of prosthetic joint infection after total hip arthroplasty. Acta Orthop. 2012;83(5):449–58. https://doi.org/10.3109/17453674.2012.733918.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Padegimas EM, Maltenfort M, Ramsey ML, Williams GR, Parvizi J, Namdari S. Periprosthetic shoulder infection in the United States: incidence and economic burden. J Shoulder Elb Surg. 2015;24(5):741–6. https://doi.org/10.1016/j.jse.2014.11.044.

    Article  Google Scholar 

  14. Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow replacement: a systematic review. J Shoulder Elb Surg. 2011;20(1):158–68. https://doi.org/10.1016/j.jse.2010.08.026.

    Article  Google Scholar 

  15. Peel TN, Dowsey MM, Buising KL, Liew D, Choong PF. Cost analysis of debridement and retention for management of prosthetic joint infection. Clin Microbiol Infect. 2013;19(2):181–6. https://doi.org/10.1111/j.1469-0691.2011.03758.x.

    Article  PubMed  CAS  Google Scholar 

  16. Marmor S, Kerroumi Y. Patient-specific risk factors for infection in arthroplasty procedure. Orthop Traumatol Surg Res. 2016;102(1 Suppl):S113–9. https://doi.org/10.1016/j.otsr.2015.05.012.

    Article  PubMed  CAS  Google Scholar 

  17. Pruzansky JS, Bronson MJ, Grelsamer RP, Strauss E, Moucha CS. Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital. J Arthroplast. 2014;29(2):272–6. https://doi.org/10.1016/j.arth.2013.06.019.

    Article  Google Scholar 

  18. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res. 2009;467(6):1577–81. https://doi.org/10.1007/s11999-008-0551-6.

    Article  PubMed  Google Scholar 

  19. Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplast. 2009;24(6 Suppl):84–8. https://doi.org/10.1016/j.arth.2009.05.016.

    Article  Google Scholar 

  20. Namba RS, Inacio MC, Paxton EW. Risk factors associated with surgical site infection in 30,491 primary total hip replacements. J Bone Joint Surg Br Vol. 2012;94(10):1330–8. https://doi.org/10.1302/0301-620x.94b10.29184.

    Article  CAS  Google Scholar 

  21. • Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013;95(9):775–82. https://doi.org/10.2106/jbjs.l.00211. Discusses risk factors for TKA.

    Article  PubMed  Google Scholar 

  22. Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.

    Article  Google Scholar 

  23. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466(7):1710–5. https://doi.org/10.1007/s11999-008-0209-4.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Peel TN, Dowsey MM, Daffy JR, Stanley PA, Choong PF, Buising KL. Risk factors for prosthetic hip and knee infections according to arthroplasty site. J Hosp Infect. 2011;79(2):129–33. https://doi.org/10.1016/j.jhin.2011.06.001.

    Article  PubMed  CAS  Google Scholar 

  25. Liabaud B, Patrick DA Jr, Geller JA. Higher body mass index leads to longer operative time in total knee arthroplasty. J Arthroplast. 2013;28(4):563–5. https://doi.org/10.1016/j.arth.2012.07.037.

    Article  Google Scholar 

  26. • Berbari EF, Osmon DR, Lahr B, Eckel-Passow JE, Tsaras G, Hanssen AD, et al. The Mayo prosthetic joint infection risk score: implication for surgical site infection reporting and risk stratification. Infect Control Hosp Epidemiol. 2012;33(8):774–81. https://doi.org/10.1086/666641. Describes use of a scoring system to help determine PJI.

    Article  PubMed  Google Scholar 

  27. •• Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302–45. https://doi.org/10.1128/cmr.00111-13. Excellent comprehensive review of PJIs.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Iorio R, Williams KM, Marcantonio AJ, Specht LM, Tilzey JF, Healy WL. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplast. 2012;27(5):726–9.e1. https://doi.org/10.1016/j.arth.2011.09.013.

    Article  Google Scholar 

  29. Seneviratne CJ, Yip JW, Chang JW, Zhang CF, Samaranayake LP. Effect of culture media and nutrients on biofilm growth kinetics of laboratory and clinical strains of Enterococcus faecalis. Arch Oral Biol. 2013;58(10):1327–34. https://doi.org/10.1016/j.archoralbio.2013.06.017.

    Article  PubMed  CAS  Google Scholar 

  30. Momohara S, Kawakami K, Iwamoto T, Yano K, Sakuma Y, Hiroshima R, et al. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol. 2011;21(5):469–75. https://doi.org/10.1007/s10165-011-0423-x.

    Article  PubMed  Google Scholar 

  31. Ruyssen-Witrand A, Fautrel B, Saraux A, Le-Loet X, Pham T. Infections induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review. Joint Bone Spine. 2010;77(3):246–51. https://doi.org/10.1016/j.jbspin.2010.02.009.

    Article  PubMed  Google Scholar 

  32. Kawakami K, Ikari K, Kawamura K, Tsukahara S, Iwamoto T, Yano K, et al. Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-alpha blockers: perioperative interruption of tumour necrosis factor-alpha blockers decreases complications? Rheumatology (Oxford). 2010;49(2):341–7. https://doi.org/10.1093/rheumatology/kep376.

    Article  CAS  Google Scholar 

  33. Hinarejos P, Guirro P, Leal J, Montserrat F, Pelfort X, Sorli ML, et al. The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees. J Bone Joint Surg Am. 2013;95(9):769–74. https://doi.org/10.2106/jbjs.l.00901.

    Article  PubMed  Google Scholar 

  34. Jamsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91(1):38–47. https://doi.org/10.2106/jbjs.g.01686.

    Article  PubMed  Google Scholar 

  35. Kaye KS, Schmit K, Pieper C, Sloane R, Caughlan KF, Sexton DJ, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis. 2005;191(7):1056–62. https://doi.org/10.1086/428626.

    Article  PubMed  Google Scholar 

  36. Lee JP, Hopf HW, Cannon-Albright LA. Empiric evidence for a genetic contribution to predisposition to surgical site infection. Wound Repair Regen. 2013;21(2):211–5. https://doi.org/10.1111/wrr.12024.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Navratilova Z, Gallo J, Mrazek F, Lostak J, Petrek M. MBL2 gene variation affecting serum MBL is associated with prosthetic joint infection in Czech patients after total joint arthroplasty. Tissue Antigens. 2012;80(5):444–51. https://doi.org/10.1111/tan.12001.

    Article  PubMed  CAS  Google Scholar 

  38. Aslam S, Reitman C, Darouiche RO. Risk factors for subsequent diagnosis of prosthetic joint infection. Infect Control Hosp Epidemiol. 2010;31(3):298–301. https://doi.org/10.1086/650756.

    Article  PubMed  Google Scholar 

  39. • Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27(5):1247–54. Guideline regarding risk factors for PJI- although this needs to be updated.

    Article  PubMed  CAS  Google Scholar 

  40. Berbari EF, Osmon DR, Carr A, Hanssen AD, Baddour LM, Greene D, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis. 2010;50(1):8–16. https://doi.org/10.1086/648676.

    Article  PubMed  Google Scholar 

  41. Uckay I, Lubbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, et al. Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect. 2009;59(5):337–45. https://doi.org/10.1016/j.jinf.2009.08.015.

    Article  PubMed  Google Scholar 

  42. • Tande AJ, Palraj BR, Osmon DR, Berbari EF, Baddour LM, Lohse CM, et al. Clinical presentation, risk factors, and outcomes of hematogenous prosthetic joint infection in patients with Staphylococcus aureus bacteremia. Am J Med. 2016;129(2):221.e11–20. https://doi.org/10.1016/j.amjmed.2015.09.006. Provides a discussion on S. aureus bacteremia and risk of infection.

    Article  Google Scholar 

  43. Cordero-Ampuero J, Gonzalez-Fernandez E, Martinez-Velez D, Esteban J. Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria? Seeding risk with/without treatment. Clin Orthop Relat Res. 2013;471(12):3822–9. https://doi.org/10.1007/s11999-013-2868-z.

    Article  PubMed  PubMed Central  Google Scholar 

  44. • Sousa R, Munoz-Mahamud E, Quayle J, Dias da Costa L, Casals C, Scott P, et al. Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis. 2014;59(1):41–7. https://doi.org/10.1093/cid/ciu235. A discussion of asymptomatic bacteruria in relation to PJI.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bozic KJ, Ong K, Lau E, Berry DJ, Vail TP, Kurtz SM, et al. Estimating risk in Medicare patients with THA: an electronic risk calculator for periprosthetic joint infection and mortality. Clin Orthop Relat Res. 2013;471(2):574–83. https://doi.org/10.1007/s11999-012-2605-z.

    Article  PubMed  Google Scholar 

  46. •• Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1–e25. https://doi.org/10.1093/cid/cis803. Guidelines regarding PJI.

    Article  PubMed  Google Scholar 

  47. Tande AJ, Gomez-Urena EO, Berbari EF, Osmon DR. Management of prosthetic joint infection. Infect Dis Clin N Am. 2017;31(2):237–52. https://doi.org/10.1016/j.idc.2017.01.009.

    Article  Google Scholar 

  48. Sollecito TP, Abt E, Lockhart PB, Truelove E, Paumier TM, Tracy SL, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners—a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015;146(1):11–6.e8. https://doi.org/10.1016/j.adaj.2014.11.012.

    Article  PubMed  Google Scholar 

  49. Jacobson JJ, Millard HD, Plezia R, Blankenship JR. Dental treatment and late prosthetic joint infections. Oral Surg Oral Med Oral Pathol. 1986;61(4):413–7.

    Article  PubMed  CAS  Google Scholar 

  50. Skaar DD, O'Connor H, Hodges JS, Michalowicz BS. Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey. J Am Dent Assoc. 2011;142(12):1343–51.

    Article  PubMed  Google Scholar 

  51. Swan J, Dowsey M, Babazadeh S, Mandaleson A, Choong PF. Significance of sentinel infective events in haematogenous prosthetic knee infections. ANZ J Surg. 2011;81(1–2):40–5. https://doi.org/10.1111/j.1445-2197.2010.05486.x.

    Article  PubMed  Google Scholar 

  52. Abad CL, Phuoc V, Kapoor P, Tande AJ, Sia IG, Tosh PK, et al. Bone and joint infections among hematopoietic stem cell transplant (HSCT) recipients open forum. Infect Dis. 2016;3(suppl_1):1127.

    Google Scholar 

  53. Vergidis P, Lesnick TG, Kremers WK, Razonable RR. Prosthetic joint infection in solid organ transplant recipients: a retrospective case-control study. Transpl Infect Dis. 2012;14(4):380–6. https://doi.org/10.1111/j.1399-3062.2011.00708.x.

    Article  PubMed  CAS  Google Scholar 

  54. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11):2992–4. https://doi.org/10.1007/s11999-011-2102-9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88(Suppl 4):138–47. https://doi.org/10.2106/JBJS.F.00609.

    Article  PubMed  Google Scholar 

  56. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92(11):2102–9. https://doi.org/10.2106/JBJS.I.01199.

    Article  PubMed  Google Scholar 

  57. Spangehl MJ, Masri BA, O'Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81(5):672–83.

    Article  PubMed  CAS  Google Scholar 

  58. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78(4):512–23.

    Article  PubMed  CAS  Google Scholar 

  59. Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, et al. Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. Scand J Infect Dis. 2004;36(6–7):410–6.

    Article  PubMed  Google Scholar 

  60. Greidanus NV, Masri BA, Garbuz DS, Wilson SD, McAlinden MG, Xu M, et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am. 2007;89(7):1409–16. https://doi.org/10.2106/JBJS.D.02602.

    Article  PubMed  Google Scholar 

  61. Christensen CP, Bedair H, Della Valle CJ, Parvizi J, Schurko B, Jacobs CA. The natural progression of synovial fluid white blood-cell counts and the percentage of polymorphonuclear cells after primary total knee arthroplasty: a multicenter study. J Bone Joint Surg Am. 2013;95(23):2081–7. https://doi.org/10.2106/JBJS.L.01646.

    Article  PubMed  Google Scholar 

  62. Bedair H, Ting N, Jacovides C, Saxena A, Moric M, Parvizi J, et al. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res. 2011;469(1):34–40. https://doi.org/10.1007/s11999-010-1433-2.

    Article  PubMed  Google Scholar 

  63. Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008;90(8):1637–43. https://doi.org/10.2106/JBJS.G.00470.

    Article  PubMed  Google Scholar 

  64. Kersey R, Benjamin J, Marson B. White blood cell counts and differential in synovial fluid of aseptically failed total knee arthroplasty. J Arthroplast. 2000;15(3):301–4.

    Article  CAS  Google Scholar 

  65. Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117(8):556–62. https://doi.org/10.1016/j.amjmed.2004.06.022.

    Article  PubMed  Google Scholar 

  66. Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90(9):1869–75. https://doi.org/10.2106/JBJS.G.01255.

    Article  PubMed  Google Scholar 

  67. Higuera CA, Zmistowski B, Malcom T, Barsoum WK, Sporer SM, Mommsen P, et al. Synovial fluid cell count for diagnosis of chronic periprosthetic hip infection. J Bone Joint Surg Am. 2017;99(9):753–9. https://doi.org/10.2106/JBJS.16.00123.

    Article  PubMed  Google Scholar 

  68. Yi PH, Cross MB, Moric M, Sporer SM, Berger RA, Della Valle CJ. The 2013 Frank Stinchfield Award: diagnosis of infection in the early postoperative period after total hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):424–9. https://doi.org/10.1007/s11999-013-3089-1.

    Article  PubMed  Google Scholar 

  69. Alvand A, Rezapoor M, Parvizi J. The role of biomarkers for the diagnosis of implant-related infections in orthopaedics and trauma. Adv Exp Med Biol. 2017;971:69–79. https://doi.org/10.1007/5584_2017_11.

    Article  PubMed  Google Scholar 

  70. Di Cesare PE, Chang E, Preston CF, Liu CJ. Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty. J Bone Joint Surg Am. 2005;87(9):1921–7. https://doi.org/10.2106/JBJS.D.01803.

    Article  PubMed  Google Scholar 

  71. Wirtz DC, Heller KD, Miltner O, Zilkens KW, Wolff JM. Interleukin-6: a potential inflammatory marker after total joint replacement. Int Orthop. 2000;24(4):194–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  72. • Bonanzinga T, Zahar A, Dutsch M, Lausmann C, Kendoff D, Gehrke T. How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study. Clin Orthop Relat Res. 2017;475(2):408–15. https://doi.org/10.1007/s11999-016-4906-0. Prospective study evaluating the performance of Alpha-defensin assay in diagnois of PJI that demonstrated good positive and negative predictive values, but concluded that more investigation was needed to compare its performance with other diagnostic tests and decrease false-positive rates in presence of metallosis.

    Article  PubMed  Google Scholar 

  73. Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Combined measurement of synovial fluid alpha-defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am. 2014;96(17):1439–45. https://doi.org/10.2106/JBJS.M.01316.

    Article  PubMed  Google Scholar 

  74. Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res. 2014;472(11):3254–62. https://doi.org/10.1007/s11999-014-3543-8.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Wyatt MC, Beswick AD, Kunutsor SK, Wilson MJ, Whitehouse MR, Blom AW. The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2016;98(12):992–1000. https://doi.org/10.2106/JBJS.15.01142.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  76. Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM, et al. Culture-negative prosthetic joint infection. Clin Infect Dis. 2007;45(9):1113–9. https://doi.org/10.1086/522184.

    Article  PubMed  Google Scholar 

  77. Mackowiak PA, Jones SR, Smith JW. Diagnostic value of sinus-tract cultures in chronic osteomyelitis. JAMA. 1978;239(26):2772–5.

    Article  PubMed  CAS  Google Scholar 

  78. Mariani BD, Tuan RS. Advances in the diagnosis of infection in prosthetic joint implants. Mol Med Today. 1998;4(5):207–13.

    Article  PubMed  CAS  Google Scholar 

  79. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357(7):654–63. https://doi.org/10.1056/NEJMoa061588.

    Article  PubMed  CAS  Google Scholar 

  80. Tunney MM, Patrick S, Curran MD, Ramage G, Hanna D, Nixon JR, et al. Detection of prosthetic hip infection at revision arthroplasty by immunofluorescence microscopy and PCR amplification of the bacterial 16S rRNA gene. J Clin Microbiol. 1999;37(10):3281–90.

    PubMed  PubMed Central  CAS  Google Scholar 

  81. De Man FH, Graber P, Luem M, Zimmerli W, Ochsner PE, Sendi P. Broad-range PCR in selected episodes of prosthetic joint infection. Infection. 2009;37(3):292–4. https://doi.org/10.1007/s15010-008-8246-1.

    Article  PubMed  Google Scholar 

  82. Gomez E, Cazanave C, Cunningham SA, Greenwood-Quaintance KE, Steckelberg JM, Uhl JR, et al. Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol. 2012;50(11):3501–8. https://doi.org/10.1128/JCM.00834-12.

    Article  PubMed  PubMed Central  Google Scholar 

  83. • Bemer P, Plouzeau C, Tande D, Leger J, Giraudeau B, Valentin AS, et al. Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection: a prospective multicenter cross-sectional study. J Clin Microbiol. 2014;52(10):3583–9. https://doi.org/10.1128/jcm.01459-14. The first prospective, multicentre study evaluating the performance of 16S rRNA test for diagnosis of PJI that demonstrated high specificity, but suboptimal sensitivity.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  84. • Hartley JC, Harris KA. Molecular techniques for diagnosing prosthetic joint infections. J Antimicrob Chemother. 2014;69(Suppl 1):i21–4. https://doi.org/10.1093/jac/dku249. A concise review on the advantages and challenges of molecular techniques for diagnosis of PJI.

    Article  PubMed  CAS  Google Scholar 

  85. Qu X, Zhai Z, Li H, Li H, Liu X, Zhu Z, et al. PCR-based diagnosis of prosthetic joint infection. J Clin Microbiol. 2013;51(8):2742–6. https://doi.org/10.1128/jcm.00657-13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  86. Gallo J, Kolar M, Dendis M, Loveckova Y, Sauer P, Zapletalova J, et al. Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection. New Microbiol. 2008;31(1):97–104.

    PubMed  Google Scholar 

  87. Lonner JH, Desai P, Dicesare PE, Steiner G, Zuckerman JD. The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplasty. J Bone Joint Surg Am. 1996;78(10):1553–8.

    Article  PubMed  CAS  Google Scholar 

  88. Pace TB, Jeray KJ, Latham JT Jr. Synovial tissue examination by frozen section as an indicator of infection in hip and knee arthroplasty in community hospitals. J Arthroplast. 1997;12(1):64–9.

    Article  CAS  Google Scholar 

  89. Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med. 1990;31(12):1950–5.

    PubMed  CAS  Google Scholar 

  90. Palestro CJ, Swyer AJ, Kim CK, Goldsmith SJ. Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology. 1991;179(3):645–8. https://doi.org/10.1148/radiology.179.3.2027967.

    Article  PubMed  CAS  Google Scholar 

  91. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351(16):1645–54. https://doi.org/10.1056/NEJMra040181.

    Article  PubMed  CAS  Google Scholar 

  92. Wilde AH. Management of infected knee and hip prostheses. Curr Opin Rheumatol. 1994;6(2):172–6.

    Article  PubMed  CAS  Google Scholar 

  93. Sia IG, Berbari EF, Karchmer AW. Prosthetic joint infections. Infect Dis Clin N Am. 2005;19(4):885–914. https://doi.org/10.1016/j.idc.2005.07.010.

    Article  Google Scholar 

  94. Byren I, Bejon P, Atkins BL, Angus B, Masters S, McLardy-Smith P, et al. One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother. 2009;63(6):1264–71. https://doi.org/10.1093/jac/dkp107.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  95. Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis. 1997;24(5):914–9.

    Article  PubMed  CAS  Google Scholar 

  96. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF. Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am. 1998;80(9):1306–13.

    Article  PubMed  CAS  Google Scholar 

  97. Drancourt M, Stein A, Argenson JN, Roiron R, Groulier P, Raoult D. Oral treatment of Staphylococcus spp. infected orthopaedic implants with fusidic acid or ofloxacin in combination with rifampicin. J Antimicrob Chemother. 1997;39(2):235–40.

    Article  PubMed  CAS  Google Scholar 

  98. Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;42(4):471–8. https://doi.org/10.1086/499234.

    Article  PubMed  CAS  Google Scholar 

  99. Tattevin P, Cremieux AC, Pottier P, Huten D, Carbon C. Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis. 1999;29(2):292–5. https://doi.org/10.1086/520202.

    Article  PubMed  CAS  Google Scholar 

  100. Iarikov D, Demian H, Rubin D, Alexander J, Nambiar S. Choice and doses of antibacterial agents for cement spacers in treatment of prosthetic joint infections: review of published studies. Clin Infect Dis. 2012;55(11):1474–80. https://doi.org/10.1093/cid/cis735.

    Article  PubMed  CAS  Google Scholar 

  101. Leung F, Richards CJ, Garbuz DS, Masri BA, Duncan CP. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res. 2011;469(4):1009–15. https://doi.org/10.1007/s11999-010-1725-6.

    Article  PubMed  Google Scholar 

  102. Sendi P, Rohrbach M, Graber P, Frei R, Ochsner PE, Zimmerli W. Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis. 2006;43(8):961–7. https://doi.org/10.1086/507633.

    Article  PubMed  Google Scholar 

  103. Bernard L, Legout L, Zurcher-Pfund L, Stern R, Rohner P, Peter R, et al. Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty. J Infect. 2010;61(2):125–32. https://doi.org/10.1016/j.jinf.2010.05.005.

    Article  PubMed  Google Scholar 

  104. •• Lora-Tamayo J, Euba G, Cobo J, Horcajada JP, Soriano A, Sandoval E, et al. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial. Int J Antimicrob Agents. 2016;48(3):310–6. https://doi.org/10.1016/j.ijantimicag.2016.05.021. First randomized trial evaluating the length of antimicrobial therapy in PJI. The study concluded that 8 weeks of combination therapy for staphylococcal PJI after debridement surgery and with implant retention may be sufficient.

    Article  PubMed  CAS  Google Scholar 

  105. Puhto AP, Puhto T, Syrjala H. Short-course antibiotics for prosthetic joint infections treated with prosthesis retention. Clin Microbiol Infect. 2012;18(11):1143–8. https://doi.org/10.1111/j.1469-0691.2011.03693.x.

    Article  PubMed  CAS  Google Scholar 

  106. Haidar R, Der Boghossian A, Atiyeh B. Duration of post-surgical antibiotics in chronic osteomyelitis: empiric or evidence-based? Int J Infect Dis. 2010;14(9):e752–8. https://doi.org/10.1016/j.ijid.2010.01.005.

    Article  PubMed  CAS  Google Scholar 

  107. Legout L, Senneville E, Stern R, Yazdanpanah Y, Savage C, Roussel-Delvalez M, et al. Treatment of bone and joint infections caused by Gram-negative bacilli with a cefepime-fluoroquinolone combination. Clin Microbiol Infect. 2006;12(10):1030–3. https://doi.org/10.1111/j.1469-0691.2006.01523.x.

    Article  PubMed  CAS  Google Scholar 

  108. Sendi P, Zimmerli W. Antimicrobial treatment concepts for orthopaedic device-related infection. Clin Microbiol Infect. 2012;18(12):1176–84. https://doi.org/10.1111/1469-0691.12003.

    Article  PubMed  CAS  Google Scholar 

  109. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA. 1998;279(19):1537–41.

    Article  PubMed  CAS  Google Scholar 

  110. Widmer AF, Frei R, Rajacic Z, Zimmerli W. Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis. 1990;162(1):96–102.

    Article  PubMed  CAS  Google Scholar 

  111. Aboltins CA, Dowsey MM, Buising KL, Peel TN, Daffy JR, Choong PF, et al. Gram-negative prosthetic joint infection treated with debridement, prosthesis retention and antibiotic regimens including a fluoroquinolone. Clin Microbiol Infect. 2011;17(6):862–7. https://doi.org/10.1111/j.1469-0691.2010.03361.x.

    Article  PubMed  CAS  Google Scholar 

  112. Martinez-Pastor JC, Munoz-Mahamud E, Vilchez F, Garcia-Ramiro S, Bori G, Sierra J, et al. Outcome of acute prosthetic joint infections due to Gram-negative bacilli treated with open debridement and retention of the prosthesis. Antimicrob Agents Chemother. 2009;53(11):4772–7. https://doi.org/10.1128/AAC.00188-09.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  113. • Siqueira MB, Saleh A, Klika AK, O'Rourke C, Schmitt S, Higuera CA, et al. Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship. J Bone Joint Surg Am. 2015;97(15):1220–32. https://doi.org/10.2106/JBJS.N.00999. Retrospective, single-centre study evaluating the role of chronic suppressive antimicrobial therapy in PJI that showed a statistically significant benefit of this approach over a 5-year period in patients who underwent debridement and implant retention and with staphylococcal PJI.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Section of Infectious Diseases, University of the Philippines, Philippine General Hospital, Taft Ave., Manila, Philippines

    C. L. Abad

  2. Department of Internal Medicine, Division of Infectious Diseases, University of Wisconsin Hospital and Clinics, Madison, WI, 53705, USA

    A. Haleem

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Abad, C.L., Haleem, A. Prosthetic Joint Infections: an Update. Curr Infect Dis Rep 20, 15 (2018). https://doi.org/10.1007/s11908-018-0622-0

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