Periprosthetic Joint Infection

Periprosthetic joint infection (PJI) is a biofilm-driven, prosthesis-specific condition distinct from native bone infection. Symptoms often include pain without fever, while diagnosis is confounded by culture-negative cases and variable presentation. Common pathogens include coagulase-negative staphylococci, S. aureus, Cutibacterium acnes, and Enterobacterales. Risk factors span modifiable (e.g., obesity, diabetes, anemia) and nonmodifiable domains (e.g., sex, mental health status, prior joint infection, operative duration). Diagnosis integrates clinical signs, serologic markers (CRP, ESR, IL-6), arthrocentesis with leukocyte/neutrophil analysis, and advanced microbiologic tools (e.g., sonication culture, metagenomics). Treatment typically requires surgery plus prolonged antibiotics, ranging from DAIR in acute cases to complex one- or two-stage revisions. Outcomes remain variable, with high costs, reduced quality of life, and long-term mortality exceeding those of aseptic failures. The review urges specialized, multidisciplinary management and expanded trials on prevention and personalized therapy.

Periprosthetic joint infection (PJI) is a biofilm-driven, prosthesis-specific condition distinct from native bone infection. Symptoms often include pain without fever, while diagnosis is confounded by culture-negative cases and variable presentation. Common pathogens include coagulase-negative staphylococci, S. aureus, Cutibacterium acnes, and Enterobacterales. Risk factors span modifiable (e.g., obesity, diabetes, anemia) and nonmodifiable domains (e.g., sex, mental health status, prior joint infection, operative duration). Diagnosis integrates clinical signs, serologic markers (CRP, ESR, IL-6), arthrocentesis with leukocyte/neutrophil analysis, and advanced microbiologic tools (e.g., sonication culture, metagenomics). Treatment typically requires surgery plus prolonged antibiotics, ranging from DAIR in acute cases to complex one- or two-stage revisions. Outcomes remain variable, with high costs, reduced quality of life, and long-term mortality exceeding those of aseptic failures. The review urges specialized, multidisciplinary management and expanded trials on prevention and personalized therapy.