Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research

Dear Colleagues,

Joint replacements are common and increasingly performed surgical procedures. The main indications for arthroplasties are to relieve pain and improve joint function in patients with advanced joint disease (mainly osteoarthritis), as well as to restore function in patients with fractures (typically femoral fractures in elderly patients). The most common joint replacements are the hip and knee, although virtually all extra-axial joints can be replaced. Prosthetic joint infections (PJI) are devastating complications with significant patient morbimortality and substantial healthcare and societal costs. While the percentage of PJIs in patients with arthroplasties could be considered low (1-3%), the increasing frequency of such procedures converts an apparently low risk into a substantial and increasing burden of infection. In most developed countries, PJI is considered a public health issue of major importance.

PJIs are a paradigm of extravascular biofilm-associated infection. The presence of biofilm influences and hinders all aspects of the prevention, diagnosis, and management of PJI. Infection eradication always requires surgery and antimicrobial therapy. Unlike other infections, however, the goal of PJI treatment is not only to eradicate infection, but also to relieve pain and maintain joint function, and not all of these outcomes are always possible in every patient. Strong collaboration between all medical and surgical specialists involved is a critical component of the care of patients with PJIs.

In this complex scenario, and in spite of the considerable amount of research performed in this field in recent decades, many unresolved questions remain about the prevention, diagnosis, treatment and outcome of PJIs; indeed, most recommendations in these areas are based on expert opinion due to the limitations of the available information. Nevertheless, these limitations also bring opportunities and the weaknesses of many of the available studies on PJI constitute a call to join forces in order to conduct well-designed international multidisciplinary studies.

This Special Issue aims to advance knowledge and expand our perspectives on the prevention, diagnosis, management, and outcome of PJIs.

Dr. Natividad Benito
Dr. Óscar Murillo
Dr. Jaime Lora-Tamayo
Guest Editors

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