Current strategies for prevention of prosthetic joint infection

Abstract

Deep sepsis still remains the second most common cause of prosthetic joint failure despite its overall incidence is decreasing. It can be defined as a bacterial growth and replication on the prosthetic joint surface resulting in periprosthetic tissue damage and prosthesis loosening. The implants are colonized by airborne-, skin-, tool-, and/or surgeon-related bacteria during surgery even though majority of procedures are performed under strictly respected conditions nowadays. After the insertion of the prosthesis into the human body the race between bacteria and host cells begins on what will colonize the prosthetic surface first. If the bacteria are more successful then they develop on formation of biofilm which is the biological correlative for the prosthetic joint infection (PJI) resisting effectively against host immune response and antibiotics. That is why preventative measures are strongly worth to do it, and removal of the prosthesis is the single optimal treatment. Each step in the pathogenesis of prosthetic joint infection may represent relevant targets against which prevention strategies may be directed. Of them the most useful seems to be identification of individual factors predisposing for PJI development, antibiotic prophylaxis given before the surgery, and operating room/ surgical quality parameters.