Antibiotic prophylaxis prior to joint replacement surgery
Treatment
Systemic and local antibiotics, joint replacement revision, debridement
Medication
Antibiotics
Frequency
Approximately 2% of hip and knee replacements
Prosthetic joint infection (PJI), also known as peri-prosthetic joint infection (PJI), is an acute, sub-acute or chronic infection of a prosthetic joint. It may occur in the period after the joint replacement or many years later. It usually presents as joint pain, erythema (redness of the joint or adjacent area), joint swelling and sometimes formation of a sinus tract ( a tract connecting the joint space to the outer environment). PJI is estimated to occur in approximately 2% of hip and knee replacements, and up to 4% of revision hip or knee replacements. Other estimates indicate that 1.4-2.5% of all joint replacements worldwide are complicated by PJIs.[1] The incidence is expected to rise significantly in the future as hip replacements and knee replacements become more common. It is usually caused by aerobic gram positive bacteria, such as Staph epidermidis or Staphylococcus aureus but enterococcus species, gram negative organisms and Cutibacterium are also known causes with fungal infections being a rare culprit. The definitive diagnosis is isolation of the causative organism from the synovial fluid (joint fluid), but signs of inflammation in the joint fluid and imaging may also aid in the diagnosis. The treatment is a combination of systemic antibiotics, debridement of infectious and necrotic tissue and local antibiotics applied to the joint space. The bacteria that usually cause prosthetic joint infections commonly form a biofilm, or a thick slime that is adherent to the artificial joint surface, thus making treatment challenging.
^Zardi, Enrico Maria; Franceschi, Francesco (1 December 2020). "Prosthetic joint infection. A relevant public health issue". Journal of Infection and Public Health. 13 (12): 1888–1891. doi:10.1016/j.jiph.2020.09.006. PMID 33289642. S2CID 226330424.
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