Approach to patients with a potential prosthetic joint infection

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Approach to patients with a potential prosthetic joint infection​

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-069502 (Published 21 March 2022) Cite this as: BMJ 2022;376:e069502

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