Diagnosis and management of prosthetic joint infection.

Joint replacement is safe, cost effective, and widely undertaken. Most prosthetic joint replacements are hips and knees; more than 130 000 people underwent such procedures in England and Wales in the 12 months from April 2006. Subsequent prosthetic joint infection is uncommon—the incidence varies between 0.6% and 2% per joint per year. However, this complication is associated with substantial morbidity and economic cost ($30 000 (£20 500; €22 800) to $50 000 per patient). 4 6 w2 The diagnosis of prosthetic joint infection is difficult, because symptoms, signs, and investigations may all be non-specific. w3 Defining diagnostic criteria and optimum management is complicated by patient heterogeneity and the small numbers inmany published studies. However, prompt recognition and diagnosis of prosthetic joint infection facilitates timely intervention to salvage infected joints, preserve joint function, prevent morbidity, and reduce costs.