Abstract
Purpose of Review
Periprosthetic joint infection (PJI) is a devastating complication that can occur following total joint arthroplasty (TJA), causing significant morbidity and often requiring revision surgery. This goal of this manuscript is to review the current evidence for the prevention and diagnosis of PJI in patients with inflammatory arthritis.
Recent Findings
Patients with inflammatory arthritis have a higher risk of PJI after TJA; however, there are several preventive, diagnostic, and therapeutic measures that can be optimized to lower the burden of PJI in this population. This manuscript will review the current evidence and clinical practice recommendations that support specific features of preoperative evaluation, perioperative medication management, and surgical planning in inflammatory arthritis patients undergoing TJA. Evidence and recommendations for the diagnosis of PJI in this patient population will also be reviewed.
Summary
Despite increased research efforts directed towards PJI, specific approaches directed at the inflammatory arthritis patient population remain surprisingly limited. Optimization strategies such as adequately managing disease-modifying medications, treating preoperative anemia, encouraging smoking cessation, and improving weight management are strongly encouraged before entering the perioperative period. If PJI does occur in the inflammatory arthritis patient, establishing the diagnosis is challenging, since guidelines were created from investigations of PJI in primarily patients without inflammatory arthritis. Future prospective research is required to better guide clinicians in preventing and diagnosing PJI in inflammatory arthritis patients undergoing TJA.
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This publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) under award number T32 AR007281. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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AP and KM performed the literature search and drafted the manuscript together. AEL, MPB, and AVC consulted with the conceptual development of the narrative and critically revised the manuscript. All listed authors approve of this manuscript and provided intellectual input.
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Ajay Premkumar, Kyle Morse, Ashley E. Levack, and Alberto V. Carli declare that they have no conflict of interest.
Dr. Bostrom reports a grant from the National Institutes of Health, during the conduct of the study. Dr. Bostrom reports other (consultant for Smith & Newphew) for relevant financial activities outside the submitted work.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Surgery and Perioperative Care
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Premkumar, A., Morse, K., Levack, A.E. et al. Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: Prevention and Diagnosis. Curr Rheumatol Rep 20, 68 (2018). https://doi.org/10.1007/s11926-018-0777-6
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DOI: https://doi.org/10.1007/s11926-018-0777-6