Key findings related to the prevention and treatment of periprosthetic joint infection (PJI), among other important topics, are presented in the new JBJS Guest Editorial What’s New in Musculoskeletal Infection. Here, we summarize the 5 most compelling studies, as selected by coauthor Jesse E. Otero, MD, PhD.
Reimplantation
A study investigated whether treatment at a specialized PJI referral center results in a better reimplantation rate than that reported by national database studies. Of the 390 patients with a confirmed PJI following total knee arthroplasty (TKA) or total hip arthroplasty (THA) who underwent a 2-stage exchange at a specialized PJI center, 99% had a reimplantation1. Guest Editorial authors Dr. Otero et al. note that “This work highlights the potential benefit of a national network of specialized PJI centers with experienced revision surgeons performing high-volume procedures to treat infection and with multidisciplinary consultants familiar with the special needs of patients with PJI.”
Infection Prevention
In a national database analysis of 221,416 THAs and 354,049 TKAs performed between 2005 and 2019, researchers found that minimal impact has been made at the population level in decreasing infection rates following THA and TKA. After controlling for confounding variables, the odds of infection marginally decreased over time for THA but marginally increased over time for TKA2.
Surgical Treatment
Recent study findings support the use of intramedullary dowels with an antibiotic spacer in resection arthroplasty for patients with periprosthetic knee infection. The researchers reported a 31% positive culture rate from femoral and tibial canals in their patient cohort, leading them to conclude that “this simple addition to an antibiotic spacer has the potential to improve 2-stage results.”3
A study assessed complications following planned retention of hip spacers in the treatment of PJI. Of the 43 included hips, 15 underwent planned spacer retention and 28 underwent 2-stage exchange. Overall survivorship free of reinfection at 5 years was acceptable, with a rate of 86%, but the retained spacer group had high rates of stem loosening, subsidence, and unplanned reoperation. The study authors advised caution in the use of planned spacer retention in healthy patients4.
Antibiotic Therapy
A single-blinded randomized controlled trial was performed to evaluate the use of intraosseous vs. intravenous administration of vancomycin prophylaxis in a cohort of 20 patients undergoing primary THA. Patients who received intraosseous vancomycin had higher local tissue concentrations and lower serum concentrations of vancomycin than those who received the antibiotic intravenously5.
What’s New in Musculoskeletal Infection is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org.
Recent OrthoBuzz posts include: What’s New in Orthopaedic Trauma, What’s New in Spine Surgery, and What’s New in Foot and Ankle Surgery.
References
- Fehring TK, Otero JE, Curtin BM, Fehring KA, Metcalf R, Rowe TM, Springer BD. Does treatment at a specialized prosthetic joint infection center improve the rate of reimplantation. J Arthroplasty. 2023 Jun;38(6S):S314-7.
- Murphy MP, MacConnell AE, Killen CJ, Schmitt DR, Wu K, Hopkinson WJ, Brown NM. Prevention techniques have had minimal impact on the population rate of prosthetic joint infection for primary total hip and knee arthroplasty: a national database study. J Arthroplasty. 2023 Jun;38(6):1131-40.
- Adrados M, Curtin BM, Springer BD, Otero JE, Fehring TK, Fehring KA. High rate of intramedullary canal culture positivity in total knee arthroplasty resection for prosthetic joint infection. J Arthroplasty. 2023 Jul;38(7):1369-72.
- Vargas-Vila MA, Siljander MP, Scudday TS, Patel JJ, Barnett SL, Nassif NA. Retained functional antibiotic hip spacers have high rates of stem loosening, subsidence, and reoperation. J Arthroplasty. 2023 Jul;38(7)(Suppl 2):S405-11.
- Harper KD, Park KJ, Brozovich AA, Sullivan TC, Serpelloni S, Taraballi F, Incavo SJ, Clyburn TA. Otto Aufranc Award: Intraosseous vancomycin in total hip arthroplasty – superior tissue concentrations and improved efficiency. J Arthroplasty. 2023 Jul;38(7S):S11-5.