Diagnosis and management of periprosthetic joint infections

Abstract

Periprosthetic joint infection (PJI) is a severe complication to hip and knee arthroplasty surgery. In the light of its devastating implications for the affected patient, its great economic impact on the health care system and the increasing antimicrobial resistance, it is important to develop efficient diagnostic methods, identify optimal treatment pathways and improve the care for patients.

Using a microbiological approach, Paper I aimed to identify the impact of biofilm production and susceptibility on clinical outcome. The result showed a greater risk of persisting PJI in patients infected by strong biofilm producing staphylococci compared to non- or weak biofilm producers, suggesting the implementation of biofilm diagnostics in clinical routine. Paper II aimed to compare two surgical techniques of DAIR (debridement, antibiotics and implant retention) treatment using a register-based approach. The superiority of modular component exchange compared to non-exchange was established and the exchange of modular components should be employed in cases where DAIR is a viable option. In terms of implant extracting treatment, Paper III aimed to identify re-revision rates after one- and two stage revision procedures using a national register. No difference in re-revision rates were observed, supporting the use of the one-stage procedure which is a more economic choice and more lenient alternative for patients. Paper IV aimed to investigate the experiences and emotional impact of PJI on surgeons using qualitative analysis. The results confirm a negative emotional impact in surgeons and highlight the importance of multi-disciplinary work and inter-collegial support for optimal PJI management and for the well-being of surgeons.