سامانه مدیریت نشریات علمی دانشگاه علوم پزشکی مشهد

Kalali, Naeemeh, Ebrahimzadeh, Mohammad H., Moradi, Ali, Jirofti, Nafiseh. (1404). Periprosthetic Joint Infection (PJI). , 13(7), 406-413. doi: 10.22038/abjs.2025.81816.3726
Naeemeh Kalali; Mohammad H. Ebrahimzadeh; Ali Moradi; Nafiseh Jirofti. "Periprosthetic Joint Infection (PJI)". , 13, 7, 1404, 406-413. doi: 10.22038/abjs.2025.81816.3726
Kalali, Naeemeh, Ebrahimzadeh, Mohammad H., Moradi, Ali, Jirofti, Nafiseh. (1404). 'Periprosthetic Joint Infection (PJI)', , 13(7), pp. 406-413. doi: 10.22038/abjs.2025.81816.3726
Kalali, Naeemeh, Ebrahimzadeh, Mohammad H., Moradi, Ali, Jirofti, Nafiseh. Periprosthetic Joint Infection (PJI). , 1404; 13(7): 406-413. doi: 10.22038/abjs.2025.81816.3726

Periprosthetic Joint Infection (PJI)

The Archives of Bone and Joint Surgery
مقاله 3، دوره 13، شماره 7، مهر 2025، صفحه 406-413    اصل مقاله (649.45 K)
نوع مقاله: CURRENT CONCEPTS REVIEW
شناسه دیجیتال (DOI): 10.22038/abjs.2025.81816.3726
نویسندگان
Naeemeh Kalali1؛ Mohammad H. Ebrahimzadeh2؛ Ali Moradi2؛ Nafiseh Jirofti* 2
11 Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran 2 Bone and Joint Research Laboratory, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
21 Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran 2 Bone and Joint Research Laboratory, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 3 Department of Regenerative Medicine and Cell Therapy, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
چکیده
Periprosthetic joint infection (PJI) is a serious complication that can occur after joint arthroplasty, 
significantly affecting both the healthcare system and patients due to high costs and mortality rates. 
Managing PJI is complex and presents significant challenges in orthopedic surgery because there is 
no standardized definition for PJI and no universally accepted diagnostic gold standard. Despite various 
preventive measures taken before and during surgery, PJIs still occur. Many treatment options are 
available, but the best management is still highly debated, and the best treatment choice depends on 
several factors. Notably, all of these treatments are taken after the occurrence of PJI, while modern 
strategies, such as coating methods with various materials, must be relied upon to control and prevent 
the occurrence of PJI. This review focuses on the precise concept of PJIs, treatment options, and novel 
strategies to prevent PJIs.
 Level of evidence: V
کلیدواژه‌ها
Joint arthroplasty؛ Orthopedic؛ Periprosthetic joint infection
مراجع
  1. Salar O, Phillips J, Porter R. Diagnosis of knee prosthetic joint infection; aspiration and biopsy. Knee. 2021; 30:249-253. doi: 10.1016/j.knee.2020.12.023.
  2. Aggarwal VK, Rasouli MR, Parvizi J. Periprosthetic joint infection: Current concept. Indian J Orthop. 2013; 47:10-17. doi: 10.4103/0019-5413.106884.
  3. Lunz A, Lehner B, Voss MN, et al. Impact and modification of the new PJI-TNM classification for periprosthetic joint infections. J Clin Med. 2023; 12(4):1262. doi: 10.3390/jcm12041262.
  4. Vasso M, Capasso L, Corona K, Pola E, Toro G, Panni AS. Periprosthetic knee infection: treatment options. Orthop Rev (Pavia). 2022; 14(4). doi: 10.52965/001c.37537.
  5. Shahi A, Tan TL, Kheir MM, Tan DD, Parvizi J. Diagnosing periprosthetic joint infection: and the winner is? J Arthroplasty. 2017; 32(9):S232-S235. doi: 10.1016/j.arth.2017.06.005.
  6. Premkumar A, Morse K, Levack AE, Bostrom MP, Carli AV. Periprosthetic joint infection in patients with inflammatory joint disease: prevention and diagnosis. Curr Rheumatol Rep. 2018; 20:1-8. doi: 10.1007/s11926-018-0777-6.
  7. Mahmoud SS, Sukeik M, Alazzawi S, Shaath M, Sabri O. Suppl-2, M4: Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements. Open Orthop J. 2016; 10:600. doi: 10.2174/1874325001610010600.
  8. Premkumar A, Kolin DA, Farley KX, et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty. 2021; 36(5):1484-1489. e3. doi: 10.1016/j.arth.2020.12.005.
  9. Slullitel PA, Oñativia JI, Buttaro MA, et al. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev. 2018; 3(7):434-441. doi: 10.1302/2058-5241.3.170032.
  10. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018; 33(5):1309-1314. e2. doi: 10.1016/j.arth.2018.02.078.
  11. Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011; 469:2992-2994. doi: 10.1007/s11999-011-2102-9.
  12. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet. 2016; 387(10016):386-394. doi: 10.1016/S0140-6736(14)61798-0.
  13. Patel R. Periprosthetic joint infection. N Engl J Med. 2023; 388(3):251-262. doi: 10.1056/NEJMra2203477.
  14. Dudareva M, Barrett L, Figtree M, et al. Sonication versus tissue sampling for diagnosis of prosthetic joint and other orthopedic device-related infections. J Clin Microbiol. 2018; 56(12):10.1128/jcm. 00688-18. doi: 10.1128/JCM.00688-18.
  15. McArthur B, Abdel M, Taunton M, Osmon D, Hanssen A. Seronegative infections in hip and knee arthroplasty: periprosthetic infections with normal erythrocyte sedimentation rate and C-reactive protein level. Bone Joint J. 2015; 97(7):939-944. doi: 10.1302/0301-620X.97B7.35500.
  16. Rockov ZA, Clarke HD, Grys TE, Chang Y-HH, Schwartz AJ. Is there an optimal cutoff for aspiration fluid volume in the diagnosis of periprosthetic joint infection? J Arthroplasty. 2020; 35(8):2217-2222. doi: 10.1016/j.arth.2020.03.011.
  17. Bottner F, Wegner A, Winkelmann W, Becker K, Erren M, Götze C. Interleukin-6, procalcitonin and TNF-α: markers of peri-prosthetic infection following total joint replacement. J Bone Joint Surg Br. 2007; 89(1):94-99. doi: 10.1302/0301-620X.89B1.17485.
  18. Saleh A, George J, Faour M, Klika A, Higuera C. Serum biomarkers in periprosthetic joint infections. Bone Joint Res. 2018; 7(1):85-93. doi: 10.1302/2046-3758.71.BJR-2017-0323.
  19. Hugle T, Schuetz P, Mueller B, et al. Serum procalcitonin for discrimination between septic and non-septic arthritis. Clin Exp Rheumatol. 2008; 26(3):453.
  20. Deirmengian C, Kardos K, Kilmartin P, et al. Diagnosing periprosthetic joint infection: the era of the biomarker has arrived. Clin Orthop Relat Res. 2014 v; 472(11):3254-62. doi: 10.1007/s11999-014-3543-8.
  21. Gollwitzer H, Dombrowski Y, Prodinger PM, et al. Antimicrobial peptides and proinflammatory cytokines in periprosthetic joint infection. J Bone Joint Surg Am. 2013; 95(7):644-651. doi: 10.2106/JBJS.L.00205.
  22. Wetters NG, Berend KR, Lombardi AV, Morris MJ, Tucker TL, Della Valle CJ. Leukocyte esterase reagent strips for the rapid diagnosis of periprosthetic joint infection. J Arthroplasty. 2012; 27(8):8-11. doi: 10.1016/j.arth.2012.03.037.
  23. Rak M, Barlič-Maganja D, Kavčič M, Trebše R, Cőr A. Comparison of molecular and culture method in diagnosis of prosthetic joint infection. FEMS Microbiol Lett. 2013; 343(1):42-48. doi: 10.1111/1574-6968.12125.
  24. Auñón Á, Coifman I, Blanco A, García Cañete J, Parrón‐Cambero R, Esteban J. Usefulness of a multiplex PCR assay for the diagnosis of prosthetic joint infections in the routine setting. Orthop Surg. 2022; 14(2):383-388. doi: 10.1111/os.13187.
  25. Tan J, Liu Y, Ehnert S, et al. The effectiveness of metagenomic next-generation sequencing in the diagnosis of prosthetic joint infection: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2022; 12:875822. doi: 10.3389/fcimb.2022.875822.
  26. Street TL, Sanderson ND, Atkins BL, et al. Molecular diagnosis of orthopedic-device-related infection directly from sonication fluid by metagenomic sequencing. J Clin Microbiol. 2017; 55(8):2334-2347. doi: 10.1128/JCM.00462-17.
  27. Putnis SE, Klasan A, Bott B, Ridley W, Hudson B, Coolican MR. The Microbiology of Knee Prosthetic Joint Infection and Its Influence on Persistent Infection. J Knee Surg. 2024; doi: 10.1055/a-2337-2402.
  28. Peel TN, Cheng AC, Buising KL, Choong PF. Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective? Antimicrob Agents Chemother. 2012; 56(5):2386-2391. doi: 10.1128/AAC.06246-11.
  29. Wright JA, Nair SP. Interaction of staphylococci with bone. Int J Med Microbiol. 2010; 300(2-3):193-204. doi: 10.1016/j.ijmm.2009.10.003.
  30. Kaplan SL. Recent lessons for the management of bone and joint infections. J Infect. 2014; 68:S51-S56. doi: 10.1016/j.jinf.2013.09.014.
  31. Flemming H-C, Wingender J. The biofilm matrix. Nat Rev Microbiol. 2010; 8(9):623-633. doi: 10.1038/nrmicro2415.
  32. Periasamy S, Joo H-S, Duong AC, et al. How Staphylococcus aureus biofilms develop their characteristic structure. Proc Natl Acad Sci U S A. 2012; 109(4):1281-1286. doi: 10.1073/pnas.1115006109.
  33. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999; 284(5418):1318-1322. doi: 10.1126/science.284.5418.1318.
  34. Sørensen SJ, Bailey M, Hansen LH, Kroer N, Wuertz S. Studying plasmid horizontal transfer in situ: a critical review. Nat Rev Microbiol. 2005; 3(9):700-710. doi: 10.1038/nrmicro1232.
  35. McGuinness WA, Kobayashi SD, DeLeo FR. Evasion of neutrophil killing by Staphylococcus aureus. Pathogens. 2016; 5(1):32. doi: 10.3390/pathogens5010032.
  36. Thammavongsa V, Kim HK, Missiakas D, Schneewind O. Staphylococcal manipulation of host immune responses. Nat Rev Microbiol. 2015; 13(9):529-543. doi: 10.1038/nrmicro3521.
  37. Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD, Team I. Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. PLoS One. 2016; 11(3):e0150866. doi: 10.1371/journal.pone.0150866.
  38. Karczewski D, Winkler T, Renz N, et al. A standardized interdisciplinary algorithm for the treatment of prosthetic joint infections: outcome in a centralized and specialized department. Bone Joint J. 2019; 101(2):132-139. doi: 10.1302/0301-620X.101B2.BJJ-2018-1056.R1.
  39. Sawada M, Oe K, Hirata M, et al. Linezolid versus daptomycin treatment for periprosthetic joint infections: a retrospective cohort study. J Orthop Surg Res. 2019; 14:1-8. doi: 10.1186/s13018-019-1375-7.
  40. Le Vavasseur B, Zeller V. Antibiotic therapy for prosthetic joint infections: an overview. Antibiotics (Basel). 2022; 11(4):486. doi: 10.3390/antibiotics11040486.
  41. Lovatti S, Tiecco G, Mule A, et al. Dalbavancin in bone and joint infections: a systematic review. Pharmaceuticals (Basel). 2023; 16(7):1005. doi: 10.3390/ph16071005.
  42. Steadman W, Chapman PR, Schuetz M, Schmutz B, Trampuz A, Tetsworth K. Local antibiotic delivery options in prosthetic joint infection. Antibiotics (Basel). 2023; 12(4):752. doi: 10.3390/antibiotics12040752.
  43. Keely Boyle K, Rachala S, Nodzo SR. Centers for Disease Control and Prevention 2017 guidelines for prevention of surgical site infections: review and relevant recommendations. Curr Rev Musculoskelet Med. 2018; 11:357-369. doi: 10.1007/s12178-018-9498-8.
  44. Clemente A, Cavagnaro L, Russo A, Chiarlone F, Massè A, Burastero G. Spacer exchange in persistent periprosthetic joint infection: microbiological evaluation and survivorship analysis. Arch Orthop Trauma Surg. 2023:1-10. doi: 10.1007/s00402-021-04300-5.
  45. Veerman K, Raessens J, Telgt D, Smulders K, Goosen JH. Debridement, antibiotics, and implant retention after revision arthroplasty: antibiotic mismatch, timing, and repeated DAIR associated with poor outcome. Bone Joint J. 2022; 104(4):464-471. doi: 10.1302/0301-620X.104B4.BJJ-2021-1264.R1.
  46. Longo UG, De Salvatore S, Bandini B, et al. Debridement, antibiotics, and implant retention (DAIR) for the early prosthetic joint infection of total knee and hip arthroplasties: a systematic review. J ISAKOS. 2024; 9(1):62-70. doi: 10.1016/j.jisako.2023.09.003.
  47. Yoo JJ, Kwon YS, Koo K-H, Yoon KS, Kim Y-M, Kim HJ. One-stage cementless revision arthroplasty for infected hip replacements. Int Orthop. 2009; 33:1195-1201. doi: 10.1007/s00264-008-0640-x.
  48. Wongworawat MD. Clinical faceoff: One-versus two-stage exchange arthroplasty for prosthetic joint infections. Clin Orthop Relat Res. 2013; 471(6):1750-1753. doi: 10.1007/s11999-013-2882-1.
  49. Bedair HS, Katakam A, Bedeir YH, Yeroushalmi D, Schwarzkopf R. A decision analysis of treatment strategies for acute periprosthetic joint infection: Early irrigation and debridement versus delayed treatment based on organism. J Orthop. 2020; 22:246-250. doi: 10.1016/j.jor.2020.04.003.
  50. Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon Y-M. Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: a propensity score–matched cohort study. J Arthroplasty. 2021; 36(1):298-304. doi: 10.1016/j.arth.2020.07.012.
  51. Zahar A, Kendoff DO, Klatte TO, Gehrke TA. Can good infection control be obtained in one-stage exchange of the infected TKA to a rotating hinge design? 10-year results. Clin Orthop Relat Res. 2016; 474:81-87. doi: 10.1007/s11999-015-4408-5.
  52. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J. 2013; 95(11_Supple_A):77-83. doi: 10.1302/0301-620X.95B11.32646.
  53. Zhao Y, Fan S, Wang Z, Yan X, Luo H. Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: a call for a prospective randomized trial. BMC Musculoskelet Disord. 2024; 25(1):153. doi: 10.1186/s12891-024-07229-z.
  54. Patel D, Shannon V, Sharma S, Liu J, Skie M. A Meta-Analysis of Success Rates of One-Stage Versus Two-Stage Revisions in Knee Prosthetic Joint Infections. Cureus. 2024; 16(4). doi: 10.7759/cureus.57533.
  55. Sousa R, Carvalho A, Soares D, Abreu MA. Interval between two-stage exchanges: what is optimal and how do you know? Arthroplasty. 2023; 5(1):33. doi: 10.1186/s42836-023-00185-4.
  56. Alrayes MM, Sukeik M. Two-stage revision in periprosthetic knee joint infections. World J Orthop. 2023; 14(3):113. doi: 10.5312/wjo.v14.i3.113.
  57. Malizos K, Varitimidis S. Infection in total knee arthroplasty. In:Management of periprosthetic joint infections (PJIs). Chris Arts J.J, Geurts J, eds. Woodhead Publishing; 2017.
  58. Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections? Clin Orthop Relat Res. 2015; 473(1):8-14. doi: 10.1007/s11999-014-3721-8.
  59. Geary MB, Macknet DM, Ransone MP, Odum SD, Springer BD. Why do revision total knee arthroplasties fail? A single-center review of 1632 revision total knees comparing historic and modern cohorts. J Arthroplasty. 2020; 35(10):2938-2943. doi: 10.1016/j.arth.2020.05.050.
  60. Wildeman P, Rolfson O, Söderquist B, Wretenberg P, Lindgren V. What are the long-term outcomes of mortality, quality of life, and hip function after prosthetic joint infection of the hip? A 10-year follow-up from Sweden. Clin Orthop Relat Res. 2021; 479(10):2203-2213. doi: 10.1097/CORR.0000000000001838.
  61. Falahee MH, Matthews L, Kaufer H. Resection arthroplasty as a salvage procedure for a knee with infection after a total arthroplasty. J Bone Joint Surg Am. 1987; 69(7):1013-1021.
  62. Esenwein S, Robert K, Kollig E, Ambacher T, Kutscha-Lissberg F, Muhr G. [Long-term results after resection arthroplasty according to Girdlestone for treatment of persisting infections of the hip joint]. Chirurg. 2001; 72(11):1336-43.
  63. Conway JD. Knee Arthrodesis for Recurrent Periprosthetic Knee Infection. JBJS Essent Surg Tech. 2020; 10(3):e19. doi: 10.2106/JBJS.ST.19.00027.
  64. Carr II JB, Werner BC, Browne JA. Trends and outcomes in the treatment of failed septic total knee arthroplasty: comparing arthrodesis and above-knee amputation. J Arthroplasty. 2016; 31(7):1574-1577. doi: 10.1016/j.arth.2016.01.010.
  65. Qin Y, Liu Z, Li L, et al. Comparative reinfection rate of one-stage versus two-stage revision in the management of periprosthetic joint infection following total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2024;25(1):1056. doi: 10.1186/s12891-024-08199-y.
  66. Sebastian S, Liu Y, Christensen R, Raina DB, Tägil M, Lidgren L. Antibiotic containing bone cement in prevention of hip and knee prosthetic joint infections: a systematic review and meta-
 

        analysis. J Orthop Translat. 2020; 23:53-60. doi: 10.1016/j.jot.2020.04.005.

  1. Tzeng A, Tzeng TH, Vasdev S, et al. Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies. Diagn Microbiol Infect Dis. 2015; 81(3):192-200. doi: 10.1016/j.diagmicrobio.2014.08.018.
  2. Bumgardner JD, Adatrow P, Haggard WO, Norowski PA. Emerging antibacterial biomaterial strategies for the prevention of peri-implant inflammatory diseases. Int J Oral Maxillofac Implants. 2011; 26(3):553-60.
  3. Onorato F, Masoni V, Gagliardi L, Comba LC, Rivera F. What to Know about Antimicrobial Coatings in Arthroplasty: A Narrative Review. Medicina (Kaunas). 2024; 60(4):574. doi: 10.3390/medicina60040574.
  4. Bulut HI, Okay E, Kanay E, Batibay SG, Ozkan K. Comparative effectiveness of silver-coated implants in periprosthetic infection prevention: A systematic review and meta-analysis. J Orthop. 2024:61:133-139. doi: 10.1016/j.jor.2024.10.009.
  5. Deng W, Shao H, Li H, Zhou Y. Is surface modification effective to prevent periprosthetic joint infection? A systematic review of preclinical and clinical studies. Orthop Traumatol Surg Res. 2019; 105(5):967-974. doi: 10.1016/j.otsr.2019.05.006.
  6. Xiong L, Pan Q, Jin G, Xu Y, Hirche C. Topical intrawound application of vancomycin powder in addition to intravenous administration of antibiotics: a meta-analysis on the deep infection after spinal surgeries. Orthop Traumatol Surg Res. 2014; 100(7):785-789. doi: 10.1016/j.otsr.2014.05.022.
 

 

 

 

آمار
تعداد مشاهده مقاله: 79
تعداد دریافت فایل اصل مقاله: 256