Research progress in diagnosis, prophylaxis, and treatment of periprosthetic joint infections / 中华骨科杂志

ABSTRACT

Periprosthetic joint infection (PJI) is one of the destructive complications after artificial joint replacement, which leads to postoperative joint pain, prolonged hospital stays, repeated multiple operations, dysfunction and even mortality. However, there is no specific diagnosis method for PJI. Although some progress has been made in the research of pathogenic microorganisms, diagnostic criteria, prevention strategies and treatment regimens of PJI in recent years, the quick and accurate diagnose and reducing of postoperative PJI is still the hotspot and difficulty in the field of artificial joint replacement. Gram-positive bacteria are the most common pathogenic bacteria, the prevalence of multidrug resistant pathogens, mixed bacterial infections and culture negative bacteria remain increasing. The epidemiological data of pathogen can guide clinical diagnosis and empirical use of antibiotics, which can help reducing of resistant bacteria. The International Consensus Meeting (ICM) proposed new diagnostic criteria, refined secondary criteria and assigned detailed scoring rules. New biochemical markers (such as leucocyte esterase and α-defensin, etc.), sonication of prosthesis combined with gene detection, imaging detection (such as 3-phase bone scanning labeled with technetium-99m, etc.), and next-generation sequencing is helpful to improve the accuracy of PJI diagnosis. Scientific and standardized perioperative management programs and new preventive measures, such as intraoperative application of vancomycin powder and diluted iodophor irrigation, are benefit to prevent and reduce the occurrence of PJI. Two-stage revision is still the standard intervention for chronic PJI, while one-stage revision combined with intra-articular antibiotics injection can effectively eradicate PJI in patients with acute or some chronic PJI with clear pathogenic bacteria.