Prosthetic Joint Infection – How to Deal with it Rationally

Vol 2 | Issue 2 |  July – Dec 2017 | Page 11-15 | Shantanu Patil, Anshu Shekhar, Sachin Tapasvi

Authors: Shantanu Patil [1], Anshu Shekhar [2], Sachin Tapasvi [2].

[1] Department of Translational Medicine and Research, Kattankulathur Campus, SRM University, India.
[2] The Orthopedic Speciality Clinic, Pune, India.

Address of Correspondence
Dr Shantanu Patil
Department of Translational Medicine and Research,
Kattankulathur Campus, SRM University, India


Prosthetic Joint Infection is a devastating complication both for the patient and the surgeon. It depends on many factors including patient factors, surgeon factors, surgery set up. The most important factor in management of PJI is to take care of all modifiable factors that can bring down the rate of infection. One of the critical steps is in prevention of surgical site infections and raising awareness among the surgeons and patients about the role of various screening procedures and avoiding indiscriminate antibiotic abuse. Management option includes one stage or two stage exchange arthroplasty, but the success rates are less than 90%. At times salvage surgeries like fusion, excision arthroplasty or amputation may also be needed. The present article overviews the prevention and management of PJI
Keywords: Prosthetic Joint Infection, arthroplasty, revision, salvage


1. Anseth SD, Pulido PA, Adelson WS, Patil S, Sandwell JC and Colwell CW, Jr. Fifteen-year to twenty-year results of cementless Harris-Galante porous femoral and Harris-Galante porous I and II acetabular components. J Arthroplasty. 2010; 25: 687-91.
2. Patil S, McCauley JC, Pulido P and Colwell Jr CW. How do knee implants perform past the second decade? Nineteen-to 25-year followup of the press-fit condylar design TKA. Clinical Orthopaedics and Related Research®. 2015; 473: 135-40.
3. Aggarwal VK, Rasouli MR and Parvizi J. Periprosthetic joint infection: Current concept. Indian Journal of Orthopaedics. 2013; 47: 10-7.
4. Bozic KJ, Kurtz SM, Lau E, et al. The Epidemiology of Revision Total Knee Arthroplasty in the United States. Clinical Orthopaedics and Related Research®. 2010; 468: 45-51.
5. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP and Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009; 91: 128-33.
6. Lenguerrand E, Whitehouse MR, Beswick AD, Jones SA, Porter ML and Blom* AW. Revision for prosthetic joint infection following hip arthroplasty. Bone and Joint Research. 2017; 6: 391-8.
7. Springer BD, Cahue S, Etkin CD, Lewallen DG and McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplasty Today. 2017; 3: 137-40.
8. Zhu M, Ravi S, Frampton C, Luey C and Young S. New Zealand Joint Registry data underestimates the rate of prosthetic joint infection. Acta Orthop. 2016; 87: 346-50.
9. Witso E. The rate of prosthetic joint infection is underestimated in the arthroplasty registers. Acta Orthop. 2015; 86: 277-8.
10. Gundtoft PH, Overgaard S, Schonheyder HC, Moller JK, Kjaersgaard-Andersen P and Pedersen AB. The “true” incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties: a prospective cohort study. Acta Orthop. 2015; 86: 326-34.
11. Kurtz SM, Lau E, Watson H, Schmier JK and Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012; 27: 61-5.e1.
12. Laura Matsen Ko M, Javad Parvizi, MD, FRCS. Diagnosis of Periprosthetic Infection Novel Developments. Orthop Clin N Am 2016; 47: 1-9.
13. Parvizi J, Gehrke T and Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone & Joint Journal. 2013; 95-B: 1450-2.
14. Mahmud T, Lyons MC, Naudie DD, MacDonald SJ and McCalden RW. Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA. Clinical Orthopaedics and Related Research. 2012; 470: 2730-6.
15. Million M, Bellevegue L, Labussiere AS, et al. Culture-negative prosthetic joint arthritis related to Coxiella burnetii. The American journal of medicine. 2014; 127: 786.e7-.e10.
16. Pavoni GL, Giannella M, Falcone M, et al. Conservative medical therapy of prosthetic joint infections: retrospective analysis of an 8-year experience. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2004; 10: 831-7.
17. Castelli CC, Gotti V and Ferrari R. Two-stage treatment of infected total knee arthroplasty: two to thirteen year experience using an articulating preformed spacer. Int Orthop. 2014; 38: 405-12.
18. Segawa H, Tsukayama DT, Kyle RF, Becker DA and Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999; 81: 1434-45.
19. Puhto AP PT, Syrjala H Short-course antibiotics for prosthetic joint infections treated with prosthesis retention. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2012; 18: 1143-8.
20. Qasim SN, Swann A and Ashford R. The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement – a literature review. SICOT-J. 2017; 3: 2.
21. Parkinson RW, Kay PR and Rawal A. A case for one-stage revision in infected total knee arthroplasty? Knee. 2011; 18: 1-4.
22. Goldman RT, Scuderi GR and Insall JN. 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res. 1996: 118-24.
23. Mah TF and O’Toole GA. Mechanisms of biofilm resistance to antimicrobial agents. Trends in microbiology. 2001; 9: 34-9.
24. Parvizi J, Shohat N and Gehrke T. Prevention of periprosthetic joint infection: new guidelines. Bone Joint J. 2017; 99-b: 3-10.
25. Senthi S, Munro JT and Pitto RP. Infection in total hip replacement: meta-analysis. Int Orthop. 2011; 35: 253-60.

How to Cite this article: Patil S, Shekhar A, Tapasvi S. Prosthetic Joint Infection – How to deal with it Rationally. Journal of Clinical Orthopaedics July-Dec 2017; 2(2):11-15

(Abstract    Full Text HTML)      (Download PDF)

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *