Prevention of periprosthetic joint infection: Pre-, intra-, and post-operative strategies

Total joint arthroplasty (TJA) is the ultimate treatment for degenerative joint disease. It restores function in the majority of patients and improves quality of life. It is projected that by the year 2030 the total number of primary total knee arthroplasty (TKA) procedures in the United States will reach 3.48 million per year, a 673% increase in comparison with the number of procedures in 2005. Furthermore, the demand for total hip arthroplasty (THA) is projected to grow by 174%, which would be 572 000 procedures per year. That is about 4 million TJAs per year. Similar to all medical interventions, TJA is accompanied by some complications, the most challenging of which is periprosthetic joint infection (PJI). Infection is the leading cause of revision after TKA and the third most common reason for revision THA in the Medicare population. PJI can occur any time after the surgery, and there is no ‘gold standard’ for diagnosis. PJI has a huge financial impact on the healthcare system. Revision due to infection cost about $320 million in 2001, increased to $566 million in 2009, and is projected to exceed $1.62 billion by 2020 in the United States. Prevention of PJI is therefore imperative. Definition of PJI