In this post, Nicolas S. Piuzzi, MD reflects on the profound human cost of periprosthetic joint infection. Dr. Piuzzi is a co-author of the Expert Review article now in JBJS, Global Perspectives on the Management of Periprosthetic Joint Infection.
This post is the first in a new series on OrthoBuzz, “Author 360,” providing insights and author perspectives on featured JBJS content. Expert Review articles present comprehensive, authoritative reviews highlighting recent advances, emerging trends, and future directions in a particular area of orthopaedic research.
Periprosthetic joint infection (PJI) remains one of the most devastating complications in orthopaedic surgery. This is not only because of its complexity, but because of the human cost it carries. Despite advances in diagnostics, surgical techniques, and antibiotic strategies, patients who develop PJI after total joint arthroplasty face a 5-year mortality rate of 15% to 25%, which is higher than that of many common cancers1,2.
These numbers, however, only hint at the real burden. One of my patients, a 73-year-old retired teacher, active and independent before her hip replacement, underwent 4 operations in 2 years after developing a PJI. She lost strength, confidence, and mobility. Even after infection control, she described her life as “a series of recoveries.” Her story is not unique. Each failed intervention represents not just surgical fatigue, but emotional and financial exhaustion. This affects everyone involved: patients, families, physicians and the health system alike. This burden transcends borders and is felt in every corner of the world.
As surgeons, we often navigate this terrain with limited answers. Despite our best efforts, we still at times “fly blind,” without reliable early biomarkers, predictive tools, or dedicated multidisciplinary centers of excellence to guide decision-making. We rely on judgment, experience, and collaboration, yet the biology and complexity of this disease continue to outpace our current understanding, challenging even the most seasoned teams.
Our JBJS Expert Review brings together international perspectives on the state of PJI management, from diagnostic standardization to evolving surgical strategies, and emerging frontiers in innovation and research. The message is clear: progress requires global collaboration, integration of precision medicine, and multidisciplinary frameworks that unite orthopaedics, microbiology, and immunology.
Ultimately, what drives our work is simple: the patient in front of us. The one struggling to walk, to return to work, or to believe recovery is still possible. PJI is not just a complication—it’s a chronic, life-altering disease. And until we find better answers, our mission as surgeons and scientists must remain focused on restoring not only mobility, but quality of life and hope.
Nicolas S. Piuzzi, MD is an orthopaedic surgeon specializing in adult joint reconstruction at the Cleveland Clinic in Cleveland, Ohio. He also serves as a member of the JBJS Executive Editorial Council.
Read more in the November 19, 2025 special issue of JBJS focused on the theme of infection.
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References
- Ramos MS, Benyamini B, Kompala V, Khan ST, Kunze KN, McLaughlin JP, Visperas A, Piuzzi NS. Periprosthetic Joint Infection Mortality After Total Hip Arthroplasty Is Comparable to 5-Year Rates of Common Cancers: A Meta-Analysis. J Arthroplasty. 2025 Apr 29:S0883-5403(25)00373-0.
- Campbell DG, Davis JS, de Steiger RN, Lorimer MF, Harries D, Harris IA, Manning L, Lewis PL. Long-Term Mortality Associated with Periprosthetic Infection in Total Hip Arthroplasty: A Registry Study of 4,651 Revisions for Infection. J Bone Joint Surg Am. 2025 Jun 3;107(14):1620-7.
Photo by National Institute of Allergy and Infectious Diseases on Unsplash.
