It has been certificated that hip and knee arthroplasty can improve quality of life and relieving pain and discomfort for ageing population and patients with muscloskeletal disorders. However, the outcomes of prosthetic joint infections (PJI) after arthroplasty usually are disastrous. The incidence of PJI is lower, but the number of this population is huge, which makes the strong impacts on quality of life for patients and healthcare economics. This review discusses the prevention strategies of PJI based on clinical epidemiology, diagnostic definition, pathogenesis, microbiology and risk factors, combined with some guidelines for prevention surgical site infections published recently.
Citation: GE Maojun. Prevention for prosthetic joint infection. West China Medical Journal, 2019, 34(3): 243-250. doi: 10.7507/1002-0179.201902017 Copy
1. | Zmistowski B, Karam JA, Durinka JB, et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am, 2013, 95(24): 2177-2184. |
2. | Charnley J. Arthroplasty of the hip. A new operation. Lancet, 1961, 1(7187): 1129-1132. |
3. | Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785. |
4. | Jafari SM, Coyle C, Mortazavi S, et al. Revision hip arthroplasty infection is the most common cause of failure. Clin Orthop Relat Res, 2010, 468(8): 2046-2051. |
5. | Bozic KJ, Berry D, Parvizi J, et al. Prosthetic joint infection risk after TKA in the medicare population. Clin Orthop Relat Res, 2010, 468(1): 52-56. |
6. | Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am, 2005, 87(8): 1746-1751. |
7. | Klouche S, Sariali E, Mamoudy P. Total hip arthroplasty revision due to infection: a cost analysis approach. Orthop Traumatol Surg Res, 2010, 96(2): 124-132. |
8. | Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res, 2010, 468(1): 45-51. |
9. | Toulson C, Walcott-Sapp S, Hur J, et al. Treatment of infected total hip arthroplasty with a 2-stage reimplantation protocol update on " our institution’s” experience from 1989 to 2003. J Arthroplasty, 2009, 24(7): 1051-1060. |
10. | Berend KR, Lombardi AV, Morris MJ, et al. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res, 2013, 471(2): 510-518. |
11. | Coello R, Charlett A, Wilson J, et al. Adverse impact of surgical site infections in English hospitals. J Hosp Infect, 2005, 60(2): 93-103. |
12. | Public Health England. Protocol for the surveillance of surgical site infection. Version 6[June 2013] r1. (2017-07-28)[2019-01-01] . https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/633775/surgical_site_infections_protocol_version_6.pdf. |
13. | Ong KL, Kurtz SM, Lau E, et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty, 2009, 24(6 Suppl): 105-109. |
14. | Kurtz SM, Ong KL, Lau E, et al. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res, 2010, 468(1): 52-56. |
15. | Tsaras G, Osmon DR, Mabry T, et al. Incidence, secular trends, and outcomes of prosthetic joint infection: a population-based study, olmsted county, Minnesota, 1969-2007. Infect Control Hosp Epidemiol, 2012, 33(12): 1207-1212. |
16. | Kurtz SM, Lau E, Watson H, et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty, 2012, 27(8 Suppl): 61-65.e1. |
17. | Malpiedi PJ, Peterson KD, Soe MM, et al. 2011 National and state healthcare-associated infection standardized infection ratio report. (2013-02-11)[2019-01-01]. http://www.cdc.gov/hai/national-annual-sir/index.html. |
18. | European Centre for Disease Prevention and Control. Surveillance of surgical site infection in Europe, 2008-2009. Stockholm: ECDC, 2012. |
19. | 赵明明, 任磊, 刘卫兵, 等. 人工关节置换术切口感染因素调查. 中国消毒学杂志, 2014, 31(12): 1339-1340. |
20. | 吴建浓, 干铁儿, 周亚芬, 等. 人工关节置换术患者术后医院感染危险因素分析. 中华医院感染学杂志, 2014, 24(21): 5357-5359. |
21. | 南玲, 刘丁, 黄庆宁, 等. 人工关节置换手术部位感染发病率及危险因素分析. 中国消毒学杂志, 2017, 34(7): 664-666. |
22. | Parvizi J, Della Valle CJ. AAOS clinical practice guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg, 2010, 18(12): 771-772. |
23. | 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(11): 2992-2994. |
24. | Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1): e1-e25. |
25. | Parvizi J. New definition for periprosthetic joint infection. Am J Orthop (Belle Mead NJ), 2011, 40(12): 614-615. |
26. | 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. |
27. | Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J, 2013, 95-B(11): 1450-1452. |
28. | Atkins GJ, Alberdi MT, Beswick AA, et al. General assembly, prevention, surgical site preparation: proceedings of international consensus on orthopedic infections. J Arthroplasty, 2019, 34(2, S): S85-S92. |
29. | Hozack WJ, Parvizi J. New definition for periprosthetic joint infection. J Arthroplasty, 2011, 26(8): 1135. |
30. | Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med, 2004, 351(16): 1645-1654. |
31. | Zimmerli W, Lew PD, Waldvogel FA. Pathogenesis of foreign body infection. Evidence for a local granulocyte defect. J Clin Invest, 1984, 73(4): 1191-1200. |
32. | Tande AJ, Gomez-Urena EO, Berbari EF, et al. Manage ment of prosthetic joint infection. Infect Dis Clin North Am, 2017, 31(2): 237-252. |
33. | Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty, 2014, 29(7): 1331. |
34. | Beam E, Osmon D. Prosthetic joint infection update. Infect Dis Clin North Am, 2018, 32(4): 843-859. |
35. | Bedair H, Ting N, Jacovides C, et al. The mark coventry award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res, 2011, 469(1): 34-40. |
36. | Cobo F, Rodriguez-Granger J, Lopez EM, et al. Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report. Infect Dis (Lond), 2017, 49(2): 81-94. |
37. | Carrega G, Bartolacci V, Burastero G, et al. Prosthetic joint infections due to Mycobacterium tuberculosis: a report of 5 cases. Int J Surg Case Rep, 2013, 4(2): 178-181. |
38. | Su JY, Huang TL, Lin SY. Total knee arthroplasty in tuberculous arthritis. Clin Orthop Relat Res, 1996(323): 181-187. |
39. | Gomez E, Chiang T, Louie T, et al. Prosthetic joint infection due to Mycobacterium bovis after intravesical instillation of bacillus Calmette-Guerin (BCG). Int J Microbiol, 2009, 2009: 527208. |
40. | Berbari EF, Marculescu C, Sia I, et al. Culture-negative prosthetic joint infection. Clin Infect Dis, 2007, 45(9): 1113-1119. |
41. | Chirca I, Marculescu C. Prevention of infection in orthopedic prosthetic surgery. Infect Dis Clin North Am, 2017, 31(2): 253-263. |
42. | Pruzansky JS, Bronson MJ, Grelsamer RP, et al. Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital. J Arthroplasty, 2014, 29(2): 272-276. |
43. | Namba RS, Inacio M, Paxton EW. Risk factors associated with surgical site infection in 30491 primary total hip replacements. J Bone Joint Surg Br, 2012, 94(10): 1330-1338. |
44. | Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res, 2009, 467(6): 1577-1581. |
45. | Peel TN, Dowsey MM, Daffy JR, et al. Risk factors for prosthetic hip and knee infections according to arthroplasty site. J Hosp Infect, 2011, 79(2): 129-133. |
46. | Liabaud B, Patrick DJ, Geller JA. Higher body mass index leads to longer operative time in total knee arthroplasty. J Arthroplasty, 2013, 28(4): 563-565. |
47. | Teo BJ, Yeo W, Chong HC, et al. Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery. J Orthop Surg (Hong Kong), 2018, 26(2): 614445935. |
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49. | Berbari EF, Osmon DR, Lahr B, et al. The Mayo prosthetic joint infection risk score: implication for surgical site infection reporting and risk stratification. Infect Control Hosp Epidemiol, 2012, 33(8): 774-781. |
50. | Yi PH, Frank RM, Vann E, et al. Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty?. Clin Orthop Relat Res, 2015, 473(1): 175-182. |
51. | Mraovic B, Suh D, Jacovides C, et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty. J Diabetes Sci Technol, 2011, 5(2): 412-418. |
52. | Jamsen E, Nevalainen PI, Eskelinen AA, et al. Risk factors for perioperative hyperglycemia in primary hip and knee replacements. Acta Orthop, 2015, 86(2): 175-182. |
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- 1. Zmistowski B, Karam JA, Durinka JB, et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am, 2013, 95(24): 2177-2184.
- 2. Charnley J. Arthroplasty of the hip. A new operation. Lancet, 1961, 1(7187): 1129-1132.
- 3. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
- 4. Jafari SM, Coyle C, Mortazavi S, et al. Revision hip arthroplasty infection is the most common cause of failure. Clin Orthop Relat Res, 2010, 468(8): 2046-2051.
- 5. Bozic KJ, Berry D, Parvizi J, et al. Prosthetic joint infection risk after TKA in the medicare population. Clin Orthop Relat Res, 2010, 468(1): 52-56.
- 6. Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am, 2005, 87(8): 1746-1751.
- 7. Klouche S, Sariali E, Mamoudy P. Total hip arthroplasty revision due to infection: a cost analysis approach. Orthop Traumatol Surg Res, 2010, 96(2): 124-132.
- 8. Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res, 2010, 468(1): 45-51.
- 9. Toulson C, Walcott-Sapp S, Hur J, et al. Treatment of infected total hip arthroplasty with a 2-stage reimplantation protocol update on " our institution’s” experience from 1989 to 2003. J Arthroplasty, 2009, 24(7): 1051-1060.
- 10. Berend KR, Lombardi AV, Morris MJ, et al. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res, 2013, 471(2): 510-518.
- 11. Coello R, Charlett A, Wilson J, et al. Adverse impact of surgical site infections in English hospitals. J Hosp Infect, 2005, 60(2): 93-103.
- 12. Public Health England. Protocol for the surveillance of surgical site infection. Version 6[June 2013] r1. (2017-07-28)[2019-01-01] . https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/633775/surgical_site_infections_protocol_version_6.pdf.
- 13. Ong KL, Kurtz SM, Lau E, et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty, 2009, 24(6 Suppl): 105-109.
- 14. Kurtz SM, Ong KL, Lau E, et al. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res, 2010, 468(1): 52-56.
- 15. Tsaras G, Osmon DR, Mabry T, et al. Incidence, secular trends, and outcomes of prosthetic joint infection: a population-based study, olmsted county, Minnesota, 1969-2007. Infect Control Hosp Epidemiol, 2012, 33(12): 1207-1212.
- 16. Kurtz SM, Lau E, Watson H, et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty, 2012, 27(8 Suppl): 61-65.e1.
- 17. Malpiedi PJ, Peterson KD, Soe MM, et al. 2011 National and state healthcare-associated infection standardized infection ratio report. (2013-02-11)[2019-01-01]. http://www.cdc.gov/hai/national-annual-sir/index.html.
- 18. European Centre for Disease Prevention and Control. Surveillance of surgical site infection in Europe, 2008-2009. Stockholm: ECDC, 2012.
- 19. 赵明明, 任磊, 刘卫兵, 等. 人工关节置换术切口感染因素调查. 中国消毒学杂志, 2014, 31(12): 1339-1340.
- 20. 吴建浓, 干铁儿, 周亚芬, 等. 人工关节置换术患者术后医院感染危险因素分析. 中华医院感染学杂志, 2014, 24(21): 5357-5359.
- 21. 南玲, 刘丁, 黄庆宁, 等. 人工关节置换手术部位感染发病率及危险因素分析. 中国消毒学杂志, 2017, 34(7): 664-666.
- 22. Parvizi J, Della Valle CJ. AAOS clinical practice guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg, 2010, 18(12): 771-772.
- 23. 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(11): 2992-2994.
- 24. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1): e1-e25.
- 25. Parvizi J. New definition for periprosthetic joint infection. Am J Orthop (Belle Mead NJ), 2011, 40(12): 614-615.
- 26. 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.
- 27. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J, 2013, 95-B(11): 1450-1452.
- 28. Atkins GJ, Alberdi MT, Beswick AA, et al. General assembly, prevention, surgical site preparation: proceedings of international consensus on orthopedic infections. J Arthroplasty, 2019, 34(2, S): S85-S92.
- 29. Hozack WJ, Parvizi J. New definition for periprosthetic joint infection. J Arthroplasty, 2011, 26(8): 1135.
- 30. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med, 2004, 351(16): 1645-1654.
- 31. Zimmerli W, Lew PD, Waldvogel FA. Pathogenesis of foreign body infection. Evidence for a local granulocyte defect. J Clin Invest, 1984, 73(4): 1191-1200.
- 32. Tande AJ, Gomez-Urena EO, Berbari EF, et al. Manage ment of prosthetic joint infection. Infect Dis Clin North Am, 2017, 31(2): 237-252.
- 33. Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty, 2014, 29(7): 1331.
- 34. Beam E, Osmon D. Prosthetic joint infection update. Infect Dis Clin North Am, 2018, 32(4): 843-859.
- 35. Bedair H, Ting N, Jacovides C, et al. The mark coventry award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res, 2011, 469(1): 34-40.
- 36. Cobo F, Rodriguez-Granger J, Lopez EM, et al. Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report. Infect Dis (Lond), 2017, 49(2): 81-94.
- 37. Carrega G, Bartolacci V, Burastero G, et al. Prosthetic joint infections due to Mycobacterium tuberculosis: a report of 5 cases. Int J Surg Case Rep, 2013, 4(2): 178-181.
- 38. Su JY, Huang TL, Lin SY. Total knee arthroplasty in tuberculous arthritis. Clin Orthop Relat Res, 1996(323): 181-187.
- 39. Gomez E, Chiang T, Louie T, et al. Prosthetic joint infection due to Mycobacterium bovis after intravesical instillation of bacillus Calmette-Guerin (BCG). Int J Microbiol, 2009, 2009: 527208.
- 40. Berbari EF, Marculescu C, Sia I, et al. Culture-negative prosthetic joint infection. Clin Infect Dis, 2007, 45(9): 1113-1119.
- 41. Chirca I, Marculescu C. Prevention of infection in orthopedic prosthetic surgery. Infect Dis Clin North Am, 2017, 31(2): 253-263.
- 42. Pruzansky JS, Bronson MJ, Grelsamer RP, et al. Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital. J Arthroplasty, 2014, 29(2): 272-276.
- 43. Namba RS, Inacio M, Paxton EW. Risk factors associated with surgical site infection in 30491 primary total hip replacements. J Bone Joint Surg Br, 2012, 94(10): 1330-1338.
- 44. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res, 2009, 467(6): 1577-1581.
- 45. Peel TN, Dowsey MM, Daffy JR, et al. Risk factors for prosthetic hip and knee infections according to arthroplasty site. J Hosp Infect, 2011, 79(2): 129-133.
- 46. Liabaud B, Patrick DJ, Geller JA. Higher body mass index leads to longer operative time in total knee arthroplasty. J Arthroplasty, 2013, 28(4): 563-565.
- 47. Teo BJ, Yeo W, Chong HC, et al. Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery. J Orthop Surg (Hong Kong), 2018, 26(2): 614445935.
- 48. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am, 2013, 95(9): 775-782.
- 49. Berbari EF, Osmon DR, Lahr B, et al. The Mayo prosthetic joint infection risk score: implication for surgical site infection reporting and risk stratification. Infect Control Hosp Epidemiol, 2012, 33(8): 774-781.
- 50. Yi PH, Frank RM, Vann E, et al. Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty?. Clin Orthop Relat Res, 2015, 473(1): 175-182.
- 51. Mraovic B, Suh D, Jacovides C, et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty. J Diabetes Sci Technol, 2011, 5(2): 412-418.
- 52. Jamsen E, Nevalainen PI, Eskelinen AA, et al. Risk factors for perioperative hyperglycemia in primary hip and knee replacements. Acta Orthop, 2015, 86(2): 175-182.
- 53. American Diabetes Association. Standards of medical care in diabetes-2016: summary of revisions. Diabetes Care, 2016, 39(Suppl 1): S4-S5.
- 54. Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. J Rheumatol, 2011, 38(9): 1824-1834.
- 55. Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg, 2011, 253(6): 1082-1093.
- 56. Keely BK, 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(3): 357-369.
- 57. Momohara S, Kawakami K, Iwamoto T, et al. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol, 2011, 21(5): 469-475.
- 58. World Health Organization. Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization, 2018.
- 59. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg, 2017, 152(8): 784-791.
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