What’s New in the Diagnosis and Treatment of Orthopedic Prostheses-Related Infections

Abstract

Periprosthetic joint infection (PJI) is one of the leading cause of failure in prosthetic joint surgery regardless the implantation site, causing an important burden to hospitals and society. Diagnosis is challenging, as there is lack of a gold standard test. When it is diagnosed within 30 days of onset or if the etiology is hematogenous with either a susceptible or non-virulent microorganism, the recommended surgical management option is debridement and irrigation, followed with antimicrobial treatment in order to preserve the device, with different reported success rates. In those cases of delayed and late onset presentation, there are two treatment possibilities: (a) Two-stage exchange arthroplasty, the most common surgical procedure for the management of PJI. Once prosthesis is removed it is followed by pathogen-specific antimicrobial treatment. A period of 2–4 weeks without antimicrobial before reimplantation procedure is suggested. (b) One-stage exchange arthroplasty is considered in case of a known microorganism that is susceptible with effective antimicrobial options and lack of sepsis. In terms of antimicrobial treatment, length of intravenous antibiotics is at surgeon’s discretion because there is not a standard recommendation. Switching from intravenous to oral antimicrobial treatment reduces the hospital length of stay and health-care expenditures. Oral antimicrobial treatment length recommendation is variable, which can be from 2 to 6 weeks to 3–6 months. Suppressive antimicrobials for a long-term are an option when prostheses retention is decided because there is a high surgical risk, poor functional outcomes, and patient preferences. PJIs are ideally treated in referral hospitals with an experienced multidisciplinary team.