Muhammad Andry Usman


The number of cases handled by PJI is projected to rise in the coming years. The diagnosis of PJI relies on evaluating microbiology, inflammatory response, and pathology. However, the accuracy of the diagnosis is compromised by previous exposure to antimicrobial agents, the possibility of contamination, and the lack of specificity of inflammatory markers. Although new testing methods, such as molecular techniques, hold the potential for a swift diagnosis, they are constrained by the risk of contamination and the absence of susceptibility results. Interestingly, emerging synovial fluid markers exhibit promise as an additional tool in diagnosing PJI. The management of each PJI case, both in terms of surgery and antimicrobial treatment, requires an individualized assessment. It is imperative to conduct high-quality studies that aim to determine the most effective route and duration of antimicrobial treatment for each surgical approach.  This review provides an overview of the diagnostic tests and treatment options for prosthetic joint infection, offering a practical approach to managing this complex clinical condition.


prosthetic joint infection; arthroplasty

Full Text:



Beam E, Osmon D. Prosthetic Joint Infection Update. Infect Dis Clin North Am. 2018;32(4):843-859. doi:10.1016/j.idc.2018.06.005

Achakri H, Bridgens J, Brittain R, et al. NJR Statistical Analysis, Support and Associated Services.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg. 2007;89(4):780-785. doi:10.2106/JBJS.F.00222

Werthel JD, Hatta T, Schoch B, Cofield R, Sperling JW, Elhassan BT. Is previous nonarthroplasty surgery a risk factor for periprosthetic infection in primary shoulder arthroplasty? J Shoulder Elbow Surg. 2017;26(4):635-640. doi:10.1016/j.jse.2016.10.020

Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales. Bone Joint J. 2015;97-B(8):1076-1081. doi:10.1302/0301-620X.97B8.35170

Adriansyah D, Santoso A, Aribowo GP, et al. THE PROFILE OF CAUSAL PATHOGEN OF HIP/ KNEE PROSTHETIC JOINT INFECTION (PJI): A SINGLE CENTER STUDY. J Musculoskelet Res. 2023;26(01). doi:10.1142/S0218957722500245

Berbari EF, Hanssen AD, Duffy MC, et al. Risk Factors for Prosthetic Joint Infection: Case‐Control Study. Clinical Infectious Diseases. 1998;27(5):1247-1254. doi:10.1086/514991

Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk Factors for Infection After Knee Arthroplasty. The Journal of Bone and Joint Surgery-American Volume. 2009;91(1):38-47. doi:10.2106/JBJS.G.01686

Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One. 2016;11(3):e0150866. doi:10.1371/journal.pone.0150866

Makki D, Elgamal T, Evans P, Harvey D, Jackson G, Platt S. The orthopaedic manifestation and outcomes of methicillin-sensitive Staphylococcus aureus septicaemia. Bone Joint J. 2017;99-B(11):1545-1551. doi:10.1302/0301-620X.99B11.BJJ-2016-1093.R1

Murdoch DR, Roberts SA, Fowler VG, et al. Infection of Orthopedic Prostheses after Staphylococcus aureus Bacteremia. Clinical Infectious Diseases. 2001;32(4):647-649. doi:10.1086/318704

Inman RD, Gallegos K V., Brause BD, Redecha PB, Christian CL. Clinical and microbial features of prosthetic joint infection. Am J Med. 1984;77(1):47-53. doi:10.1016/0002-9343(84)90434-0

Parvizi J, Gehrke T. Definition of Periprosthetic Joint Infection. J Arthroplasty. 2014;29(7):1331. doi:10.1016/j.arth.2014.03.009

Chisari E, Lin F, Fei J, Parvizi J. Fungal periprosthetic joint infection: Rare but challenging problem. Chinese Journal of Traumatology. 2022;25(2):63-66. doi:10.1016/j.cjtee.2021.12.006

Gross CE, Della Valle CJ, Rex JC, Traven SA, Durante EC. Fungal Periprosthetic Joint Infection: A Review of Demographics and Management. J Arthroplasty. 2021;36(5):1758-1764. doi:10.1016/j.arth.2020.11.005

Nace J, Siddiqi A, Talmo CT, Chen AF. Diagnosis and Management of Fungal Periprosthetic Joint Infections. Journal of the American Academy of Orthopaedic Surgeons. 2019;27(18):e804-e818. doi:10.5435/JAAOS-D-18-00331

Carrega G, Bartolacci V, Burastero G, Finocchio GC, Ronca A, Riccio G. Prosthetic joint infections due to Mycobacterium tuberculosis: A report of 5 cases. Int J Surg Case Rep. 2013;4(2):178-181. doi:10.1016/j.ijscr.2012.11.011

Su JY, Huang TL, Lin SY. Total Knee Arthroplasty in Tuberculous Arthritis. Clin Orthop Relat Res. 1996;323:181-187. doi:10.1097/00003086-199602000-00024

Gomez E, Chiang T, Louie T, Ponnapalli M, Eng R, Huang DB. Prosthetic Joint Infection due to Mycobacterium bovis after Intravesical Instillation of Bacillus Calmette-Guerin (BCG). Int J Microbiol. 2009;2009:1-4. doi:10.1155/2009/527208

Berbari EF, Marculescu C, Sia I, et al. Culture-negative prosthetic joint infection. Clinical Infectious Diseases. 2007;45(9):1113-1119. doi:10.1086/522184

Thoendel M, Jeraldo P, Greenwood-Quaintance KE, et al. A Novel Prosthetic Joint Infection Pathogen, Mycoplasma salivarium, Identified by Metagenomic Shotgun Sequencing. Clinical Infectious Diseases. 2017;65(2):332-335. doi:10.1093/cid/cix296

Gallo J, Nieslanikova E. Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining. J Clin Med. 2020;9(7):2190. doi:10.3390/jcm9072190

Tarabichi S, Parvizi J. Prevention of surgical site infection: a ten-step approach. Arthroplasty. 2023;5(1):21. doi:10.1186/s42836-023-00174-7

Barrett L, Atkins B. The clinical presentation of prosthetic joint infection. Journal of Antimicrobial Chemotherapy. 2014;69(SUPPL1). doi:10.1093/jac/dku250

Romanò CL, Romanò D, Logoluso N, Drago L. Bone and joint infections in adults: a comprehensive classification proposal. Eur Orthop Traumatol. 2011;1(6):207. doi:10.1007/s12570-011-0056-8

Parvizi J, Zmistowski B, Berbari EF, et al. New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11):2992-2994. doi:10.1007/s11999-011-2102-9

Kim SJ, Cho YJ. Current Guideline for Diagnosis of Periprosthetic Joint Infection: A Review Article. Hip Pelvis. 2021;33(1):11. doi:10.5371/hp.2021.33.1.11

Parvizi J, Tan TL, Goswami K, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018;33(5):1309-1314.e2. doi:10.1016/j.arth.2018.02.078

Brammen L, Palestro C, Sinzinger H. Radionuclide imaging: Past, present and future outlook in the diagnosis of infected prosthetic joints. Hell J Nucl Med. 2015;18 Suppl 1:95-102.

Romanò CL, Petrosillo N, Argento G, et al. The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements. J Clin Med. 2020;9(8):2548. doi:10.3390/jcm9082548

Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of Americaa. Clinical Infectious Diseases. 2013;56(1):e1-e25. doi:10.1093/cid/cis803

Lora-Tamayo J, Euba G, Cobo J, et al. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial. Int J Antimicrob Agents. 2016;48(3):310-316. doi:10.1016/j.ijantimicag.2016.05.021

Chaussade H, Uçkay I, Vuagnat A, et al. Antibiotic therapy duration for prosthetic joint infections treated by Debridement and Implant Retention (DAIR): Similar long-term remission for 6 weeks as compared to 12 weeks. International Journal of Infectious Diseases. 2017;63:37-42. doi:10.1016/j.ijid.2017.08.002

Urish KL, Bullock AG, Kreger AM, et al. A Multicenter Study of Irrigation and Debridement in Total Knee Arthroplasty Periprosthetic Joint Infection: Treatment Failure Is High. J Arthroplasty. 2018;33(4):1154-1159. doi:10.1016/j.arth.2017.11.029

Soriano A, García S, Bori G, et al. Treatment of acute post-surgical infection of joint arthroplasty. Clinical Microbiology and Infection. 2006;12(9):930-933. doi:10.1111/j.1469-0691.2006.01463.x

Nagra NS, Hamilton TW, Ganatra S, Murray DW, Pandit H. One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(10):3106-3114. doi:10.1007/s00167-015-3780-8

Lange J, Troelsen, Thomsen R, Soballe. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol. Published online March 2012:57. doi:10.2147/CLEP.S29025

Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT. Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop. 2009;80(1):67-77. doi:10.1080/17453670902805064

Javad Mortazavi SM, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage Exchange Arthroplasty for Infected Total Knee Arthroplasty: Predictors of Failure. Clin Orthop Relat Res. 2011;469(11):3049-3054. doi:10.1007/s11999-011-2030-8

Hirakawa K, Stulberg BN, Wilde AH, Bauer TW, Secic M. Results of 2-stage reimplantation for infected total knee arthroplasty. J Arthroplasty. 1998;13(1):22-28. doi:10.1016/S0883-5403(98)90071-7



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The Knee and Hip Journal has been indexed and abstracted in the following databases: