Approach to patients with a potential prosthetic joint infection

Hip and knee arthroplasty are safe, cost effective, and reliable surgical procedures that significantly improve patient quality of life by alleviating pain and restoring mobility.1 Every year, more than 2 million people in countries of the Organisation for Economic Co-operation and Development undergo hip or knee replacement, mostly for osteoarthritis.2 This number will rise with increasing life expectancy, bringing with it more patients at risk of developing a prosthetic joint infection (PJI).34

Hip and knee PJIs occur in approximately 1% of primary total hip replacements (THR) and approximately 2% of primary total knee replacements (TKR).1 PJI is a serious complication, with high morbidity and mortality (>10% mortality for patients aged over 804) and requires prolonged and complex treatment with substantial healthcare costs.5 Recent studies estimate the cost at around £36 000 to treat an infected arthroplasty.6 For revision arthroplasty, the risk of PJI is increased, occurring in approximately 4% of cases.7 Worldwide, the incidence of PJIs is similar,1 but with a considerable economic burden in developing countries, where treatment costs on average 4.5 times that of the original arthroplasty.8