A review of current practices in periprosthetic joint infection debridement and revision arthroplasty

Abstract

Background Periprosthetic joint infection remains a significant challenge for arthroplasty surgeons globally. Over the last few decades, there has been much advancement in terms of treatment and diagnosis, however, the fight rages on. As management of periprosthetic joint infections continues to evolve, it is critical to reflect back on current debridement practices to establish common ground as well as identify areas for future research and improvement. Body In order to understand the debridement techniques of periprosthetic joint infections, one must also understand how to diagnose a periprosthetic joint infection. Multiple definitions have been elucidated over the years with no single consensus established but rather sets of criteria. Once a diagnosis has been established the decision of debridement method becomes whether to proceed with single vs two-stage revision based on the probability of infection as well as individual patient factors. After much study, two-stage revision has emerged as the gold standard in the management of periprosthetic infections but single-stage remains prominent with further and further research. Conclusion Despite decades of data, there is no single treatment algorithm for periprosthetic joint infections and subsequent debridement technique. Our review touches on the goals of debridement while providing a perspective as to diagnosis and the particulars of how intraoperative factors such as intraarticular irrigation can play pivotal roles in infection eradication. By providing a perspective on current debridement practices, we hope to encourage future study and debate on how to address periprosthetic joint infections best.

The Creation of Articulating Cement Spacer Using Custom-Fabricated Silicone Mold for the Treatment of Periprosthetic Joint Infection: Two Case Reports

“…In the early 2000s, articulating and static spacers had been introduced to accelerate the eradication of infection [1]. Since then, two-stage revision remains the gold standard for the management of PJI with a success rate of 90%-100% [1][2][3][4][5][6][7][8][9][10]. Normally, the antibiotic-loaded cement spacer is inserted for six weeks prior to the second-stage revision [1,2].…”

“…Despite relatively good outcomes in most of the patients with hip and knee joint pathologies, there are several complications associated with these procedures [1][2][3][4][5][6]. One of the dreaded complications of arthroplasty surgery is periprosthetic joint infection (PJI) [6][7][8]. The incidence of PJI in the first two years after primary joint replacement ranges from 0.5% to 3%, and revision surgeries show a higher rate of infection, ranging from 2.5% to 4% [1][2][3][4][5][6][7][8][9][10].…”

“…One of the dreaded complications of arthroplasty surgery is periprosthetic joint infection (PJI) [6][7][8]. The incidence of PJI in the first two years after primary joint replacement ranges from 0.5% to 3%, and revision surgeries show a higher rate of infection, ranging from 2.5% to 4% [1][2][3][4][5][6][7][8][9][10].…”

“…PJI is associated with high rates of mortality and morbidity, adversely affecting the level of mobility and ambulation of patients, thereby reducing the quality of life [1][2][3][4][5][6][7][8][9][10]. Numerous risk factors of PJI have been identified, including advanced age, malnutrition, inflammatory diseases, obesity, diabetes mellitus, and remote infection [1][2].…”

“…Furthermore, good results of single-stage revision require a much more aggressive and complete periarticular tissue resection than two-stage, which many surgeons are not accustomed to performing [11]. As there are numerous variables that may adversely affect the outcome of single-stage revision surgeries, two-stage revision is currently considered the gold standard in the management of PJI [1][2][3][4][5][6][7][8][9][10].…”