Acute Periprosthetic Joint Infection

Periprosthetic joint infection (PJI) following total hip and total knee arthroplasty continues to be a leading cause of re-operation and revision surgery. It is estimated that PJI rates vary from 0.4% to 2.4% following primary arthroplasty and between 8% and 10% following revision arthroplasty. Compared to primary arthroplasty, revision arthroplasty for PJI is associated with higher rates of major perioperative complications including prolonged surgical time, longer hospital length of stay, and higher rates of intraoperative blood loss requiring transfusion. The diagnosis of PJI is based upon a set of criteria, as no singular test is entirely sensitive and specific. These criteria have been reviewed and altered by a group of recognized international experts during the 2018 International Consensus Meeting on PJI. Classification systems for PJIs serve to help determine the most appropriate surgical strategy for treating a PJI. These infections are often classified according to time from index surgery and/or symptom duration. The difficulty in managing PJIs is secondary to the formation of biofilm on the surface of the prosthesis. It is imperative to involve infection disease specialist early in the care of these patients to guide appropriate antibiotic therapy. The purpose of this chapter is to provide a brief, contemporary, description of treatment principles for performing debridement, antibiotics, and retention of the implant (DAIR) and single-stage exchange arthroplasty for acute and acute hematogenous PJI along with factors associated with improved chances of success.