Current concepts in the management of prosthetic joint infection.

Abstract

Prosthetic joint infection (PJI) is a serious complication of arthroplasty that is associated with significant mortality, morbidity and costs. PJI is difficult to cure because causative bacteria form and persist in biofilm adherent to the prosthesis surface. PJI can be classified into early, delayed or late according to the time of onset after insertion of the prosthesis, and this classification can help determine pathogenesis and appropriate management. Traditional treatment has been with prolonged intravenous antibiotics and prosthesis exchange, which has been successful in treating infection but is technically difficult and has high rates of associated morbidity. On the basis of in vitro and animal studies, interest has turned to the use of antimicrobials that are particularly active against biofilm-associated bacteria. Recent clinical evidence shows success in more than 77% of early PJI with surgical debridement, retention of prosthesis and the use of rifampicin-based combinations for staphylococcal PJI. Fluoroquinolones are preferred for Gram-negative PJI. Optimal antimicrobial treatment duration and the management of polymicrobial, enterococcal, fungal and culture-negative infections are still yet to be defined but will become more clear as the results of current research comes to hand.