Current treatments for biofilm‐associated periprosthetic joint infection and new potential strategies

Abstract

Periprosthetic joint infection (PJI) remains a devastating complication after total joint arthroplasty. Bacteria involved in these infections are notorious for adhering to foreign implanted surfaces and generating a biofilm matrix. These biofilms protect the bacteria from antibiotic treatment and the immune system making eradication difficult. Current treatment strategies including debridement, antibiotics, and implant retention, and one‐ and two‐stage revisions still present a relatively high overall failure rate. One of the main shortcomings that has been associated with this high failure rate is the lack of a robust approach to treating bacterial biofilm. Therefore, in this review, we will highlight new strategies that have the potential to combat PJI by targeting biofilm integrity, therefore giving antibiotics and the immune system access to the internal network of the biofilm structure. This combination antibiofilm/antibiotic therapy may be a new strategy for PJI treatment while promoting implant retention.

Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study

“…Radical treatment of PJI requires removal of the entire prosthesis and intensive debridement to the point of complete exposure. Mechanical operation should be performed to remove the biofilm, which is very important for infection control and is the primary factor for successful surgical outcome[ 3 , 16 , 17 ]. Debridement should not be forceful, and soft tissue injury and bone defect around the joint should be minimized as much as possible.…”

“…Currently, the treatment for PJI primarily includes the use of antibiotics alone, prosthetic debridement lavage, primary revision, secondary revision, joint fusion, amputation, etc. [ 3 , 4 ]. Tsukayam et al [ 5 ] grouped PJIs into four types and proposed corresponding treatment strategies: Type Ⅰ, no symptoms of infection but with positive intraoperative culture, mostly observed in preoperative diagnosis of aseptic loosening of the knee prosthesis and positive culture of the tissue specimen during revision surgery, which can be treated with intravenous antibiotics; type II, an early infection that occurs within 1 mo after surgery and can be treated by debridement to preserve the prosthesis; type III, an acute hematogenous infection that occurs suddenly in a well-functioning joint, which can also be treated, and the prosthesis is preserved; type IV, an advanced chronic infection that requires removal and revision of the prosthesis.…”

Periprosthetic joint infection and immunity: Current understanding of host–microbe interplay

“…20 Current treatments lack the ability to eliminate biofilm prompting an active area of research. 21 Due to challenges in the diagnosis of PJI, different diagnostic criteria for PJI have been developed by multiple societies around the world and include parameters of physical exam, laboratory tests of patient blood and synovial fluid, and culture of microbes (including sensitivity and specificity of cultures to antibiotics). The most current definitions are based on the 2018 International Consensus Meeting (ICM), 22 2021 European Bone and Joint Infection Society (EBJIS), 23 and the 2023 Infectious Diseases Society of America (IDSA).…”

“…This biofilm can protect bacteria from the immune system and antibiotics 20 . Current treatments lack the ability to eliminate biofilm prompting an active area of research 21 …”

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

“…Overall, definitions and criteria continue to be revised and augmented with the study of new and emerging technologies that can help guide us toward a universally-accepted set of criteria for PJI diagnosis. Some of these new technologies aimed at addressing biofilms include the following: cathodic voltage controlled electrical stimulation, electrochemical scaffolds, hyperthermia, polyclonal antibodies, antimicrobial peptides, and endogenous molecules such as bacteriophages [33][34][35]. A complete discussion of each of these technologies and their respective efficacy falls outside the scope of this paper, however, it is crucial to keep molecular level treatments in mind as we focus on the macromolecular treatments offered through standard revision arthroplasty and the debridement techniques which are the focus of this paper.…”