Orthopedic Implant Use and Infection

Abstract

While total joint arthroplasty is one of the most successful procedures in orthopedic surgery, periprosthetic infection is a devastating complication after total joint replacement that can have severe consequences that may lead to limb fusion, limb loss, and even death. Implants used in total joint arthroplasty, and other orthopedic procedures such as trauma and spine, have a propensity for attracting bacteria that lead to colonization and biofilm formation. Biofilms are traditionally resistant to antibiotic treatment strategies, and even when treated, they may leave “persisters” or persistent bacteria that may reinitiate an infection long after the index infection. Additionally, biofilms are difficult to diagnose, as they evade traditional culturing methods for microorganism detection. In order to diagnose periprosthetic joint infections, subjective decisions are usually required using diagnostic criteria combining clinical presentation, laboratory tests, and symptom duration. More recent synovial fluid molecular markers have been investigated for diagnosing periprosthetic joint infection, including C-reactive protein, alpha-defensin and interleukin-6. Treatment for periprosthetic joint infection typically includes antibiotic treatment and revision surgery in one or two stages. However, even with successful treatment, subsequent surgeries often lead to excessive pain, greater bone loss, disability, and astronomical costs to the patient and the health care system. In order to prevent periprosthetic joint infections, smart implants with antimicrobial surfaces have been developed to prevent bacterial attachment and mitigate the risk for biofilm formation. With continued development with antimicrobial coatings, periprosthetic joint infections can potentially become a problem of the past.