Risk factors, diagnosis and management of prosthetic joint infection after total hip arthroplasty

ABSTRACT

Introduction: Although a relatively rare complication, the incidence and prevalence of prosthetic joint infection (PJI) is certainly rising. This is mainly due to the number of arthroplasties performed each year and our ability to capture more cases. There is currently no consensus in the optimal diagnosis and management of the infected total hip arthroplasty. Various management techniques have been described in literature.

Areas covered: We discuss and summarize the literature in diagnosing prosthetic joint infection (PJI) including next-generation sequencing. An in-depth critical analysis of the biomarkers and the novel tests available in the market is reviewed including the evolving nature of the diagnostic criteria for PJI. The key issues in managing infected THA are identified.

Expert commentary: The senior authors' expert opinion on diagnostic criteria is discussed. We also stress the importance of tissue/fluid analysis of microbiology and histology being key to diagnosis of PJI. The indications of one-stage versus two-stage revision arthroplasty is examined, including techniques for successful one-stage revision.

KEYWORDS:

• PJI
• prosthetic joint infection
• one stage versus two stage
• alpha defensin
• next generation sequencing

Article highlights

• A positive culture result should still form the gold standard in diagnosing prosthetic joint infection

• One should be careful of over-diagnosing patients with ‘culture negative’ PJI

• There is a good role for both DAIR and one-stage revision procedures in the appropriately selected patient and should be used judiciously.

• Two-stage revision is still considered the gold standard in our institution and is reserved for complex cases or for those where the bacterial isolate is unusual or simply not known.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer is a consultant for SERF (Décines, France). Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.