The burden of prosthetic joint infection (PJI)

Abstract

Total hip and knee arthroplasty are clinically and cost effective procedures. The numbers of patients receiving these procedures are estimated to rise by 150–600% for THA and TKA respectively by 2030 (1) in the USA. The trend is similar in Europe (2,3). Along with this trend in hip and knee arthroplasty patients increasingly also have indwelling prostheses of the shoulder, elbow and ankle. Prosthetic joint infection (PJI) is potentially the most significant complication following total joint arthroplasty. It is challenging for the surgeon to manage, physically and mentally disastrous for the patient and the cost to the health care system and society as a whole is high. PJI has an impact on patients, healthcare delivery institutions and society as a whole. It has significant negative impact on patients’ psychological well being (4). The cost of treating PJI is significant. It is estimated that in the US alone the projected spend on the treatment of PJI is $1.62 billion (5). This is despite little improvement in the success rate in terms of eradication of infection (6). For these reasons there has been an increasing focus on the issue of PJI in the medical literature (6). This paper discusses the incidence of PJI as well as the factors which might account for the current trends and the challenges associated with the contemporary management of PJI. The incidence of PJI varies with the joint involved (7,8). Reported incidences following total knee arthroplasty, total hip arthroplasty and total shoulder arthroplasty have been reported to be 0.25% to 2%, 0.5% to 1% and less than 1% respectively (9,10). Between 23–25% of revision TKA procedures and 12–15% revision THA procedures are performed for PJI (11,12). Risk factors for PJI are presented in Table 1 (13). While the incidence remains low the number of patients are likely to increase over time however as the number of arthroplasty procedures performed annually increases. The incidence of PJI varies throughout the literature. As a result existing data needs to be interpreted with caution. Wang 4