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Clinical Management of Prosthetic Joint Infection (PJI)
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Clinical Management of Prosthetic Joint Infection (PJI)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 September 2025 | Viewed by 3698

Special Issue Editor

Dr. Daniel Pérez-Prieto

E-Mail Website
Guest Editor
Orthopedic Surgery and Traumatology Department, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain
Interests: orthopedic infections; lower limb infections; osteomyelitis; prosthetic joint infections; arthroscopic infections

Special Issue Information

Dear Colleagues,

Prosthetic joint infection (PJI) is a serious complication that requires prompt and appropriate management to prevent further complications and improve patient outcomes. The clinical management of PJI typically involves a combination of surgical intervention and antimicrobial therapy. Surgical options may include DAIR or one- or two-stage revision arthroplasty, as well as some other proposed approaches. Moreover, plastic surgery is often required. Antimicrobial therapy is usually tailored based on the causative organism and may involve prolonged courses of intravenous or oral antibiotics. The close monitoring and management of the patients in a MDT approach is crucial, involving not only the aforementioned specialists but also microbiologists, pathologists, pharmacists, nurses and psychologists, among others. Therefore, we invite all of them to submit their work related to PJI management for inclusion in this Special Issue.

Dr. Daniel Pérez-Prieto
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prosthetic joint infection
  • debridement
  • biofilm
  • wound healing
  • multidisciplinary team
  • osteomyelitis

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Published Papers (5 papers)

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Research

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14 pages, 1081 KiB  
Article
Evaluation of Risk Factors for Periprosthetic Joint Infection Following Reverse Shoulder Arthroplasty: A Multivariate Analysis Study
by Koray Şahin, Hakan Batuhan Kaya, Cemil Burak Demirkıran, Nezih Ziroğlu, Christos Koukos, Vahdet Uçan, Mehmet Kapıcıoğlu and Kerem Bilsel
J. Clin. Med. 2025, 14(9), 2926; https://doi.org/10.3390/jcm14092926 - 24 Apr 2025
Viewed by 252
Abstract
Background/Objectives: Reverse shoulder arthroplasty (RSA) has been widely used for the treatment of shoulder pathologies, particularly rotator cuff tear arthropathy. Currently, it is also increasingly performed for different indications. Like in any arthroplasty procedure, periprosthetic joint infection (PJI) is one of the [...] Read more.
Background/Objectives: Reverse shoulder arthroplasty (RSA) has been widely used for the treatment of shoulder pathologies, particularly rotator cuff tear arthropathy. Currently, it is also increasingly performed for different indications. Like in any arthroplasty procedure, periprosthetic joint infection (PJI) is one of the most concerning complications and may have devastating outcomes. This study aimed to identify risk factors for PJI following RSA. Methods: This retrospective case-control study was conducted with patients who underwent RSA during the study period. Based on PJI occurrence during the follow-up period, patients were divided into two groups: Group I (no infection) and Group II (infection). The relationship between numerous clinical variables and PJI was tested. All variables were initially evaluated through univariate analysis between the two groups, and variables showing significant differences between the two study groups were subjected to multivariate logistic regression analysis to determine independent risk factors. Results: The study included 302 patients, with a mean age of 69.6 ± 10.1 years and a mean follow-up duration of 59.8 ± 24.7 months. During the follow-up period, PJI was not detected in 289 patients (95.7%) (Group I), while 13 patients (4.3%) developed PJI (Group II). Univariate analysis revealed a significant association between preoperative C-reactive protein (CRP) value (p = 0.001) and preoperative diabetes history (p = 0.007) with PJI. Multivariate logistic regression analysis, including these two variables, showed that diabetes was an independent risk factor for PJI development (p = 0.01, odds ratio = 4.85). Preoperative CRP elevation was not observed as an independent risk factor. Conclusions: This study demonstrated a significant association between high preoperative CRP levels and diabetes with PJI. Additionally, the presence of diabetes was identified as an independent risk factor for infection, with a 4.85-fold higher risk of PJI development in patients with a history of diabetes. Full article
(This article belongs to the Special Issue Clinical Management of Prosthetic Joint Infection (PJI))
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12 pages, 1017 KiB  
Article
Mid- to Long-Term Outcomes of Two-Stage Revision Arthroplasty for Periprosthetic Joint Infection of the Shoulder
by Ağahan Hayta, Doruk Akgün, Anh Do, Rony-Orijit Dey Hazra, David Alexander Back, Nihat Demirhan Demirkiran, Markus Scheibel and Alp Paksoy
J. Clin. Med. 2025, 14(2), 547; https://doi.org/10.3390/jcm14020547 - 16 Jan 2025
Viewed by 937
Abstract
Background/Objectives: Periprosthetic joint infection (PJI) after shoulder arthroplasty is often treated with a two-stage approach, but the data on the mid- to long-term outcomes remain scarce. This study aimed to evaluate the clinical outcomes of two-stage revision arthroplasty for shoulder PJI with [...] Read more.
Background/Objectives: Periprosthetic joint infection (PJI) after shoulder arthroplasty is often treated with a two-stage approach, but the data on the mid- to long-term outcomes remain scarce. This study aimed to evaluate the clinical outcomes of two-stage revision arthroplasty for shoulder PJI with a minimum follow-up of five years. Methods: This retrospective study identified 59 shoulders in 58 patients who underwent the first stage of a two-stage revision arthroplasty for shoulder PJI at our institution between 2007 and 2018. Of these, 29 shoulders in 29 patients (49.2%) did not undergo reimplantation or the patient passed away before reaching five years of follow-up. The remaining 30 shoulders in 29 patients were included in the study. The clinical assessments included the active range of motion, the visual analogue scale (VAS) for pain, the Subjective Shoulder Value (SSV), the Constant Score (CS), and the 12-Item Short Form Survey (SF-12), supplemented by detailed clinical and radiological evaluations. Results: The mean age of the 29 patients was 75.9 ± 10.4 years. The average follow-up duration was 8.3 ± 2.8 years. The most common indications for primary shoulder arthroplasty were primary osteoarthritis (n = 12, 40%) and fractures (n = 12, 40%). At the first stage, nine cases (30%) showed negative cultures, while C. acnes and S. epidermidis were each identified in eight cases (26.7%). Four shoulders (13.3%) experienced recurrent infections. At the follow-up, the mean abduction was 86 ± 48.1°, the mean forward flexion was 97.8 ± 50.1°, the mean external rotation was 20.5 ± 19.9°, and the internal rotation reached the lumbosacral region. The mean VAS pain score was 1.5 ± 2.1, the mean SSV was 51.8 ± 28.4%, the mean CS was 54.6 ± 21.0, and the mean SF-12 was 81.0 ± 16.0. Conclusions: Two-stage revision arthroplasty for shoulder PJI results in satisfactory subjective and objective outcomes, with a low overall reinfection rate. However, the high rates of mortality and failure to reimplant must be carefully considered when managing expectations in this challenging cohort. Full article
(This article belongs to the Special Issue Clinical Management of Prosthetic Joint Infection (PJI))
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Review

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21 pages, 2818 KiB  
Review
Unconventional Therapies in Periprosthetic Joint Infections: Prevention and Treatment: A Narrative Review
by Daniyil Semeshchenko, Pablo A. Slullitel, Alicia Farinati, Agustin F. Albani-Forneris, Nicolas S. Piuzzi and Martin A. Buttaro
J. Clin. Med. 2025, 14(8), 2610; https://doi.org/10.3390/jcm14082610 - 10 Apr 2025
Viewed by 573
Abstract
Background: as the demand for total joint arthroplasty continues to grow each year, the healthcare burden is expected to increase due to periprosthetic joint infection (PJI). This review article aims to highlight the significance of biofilms in the pathogenesis of PJI and introduce [...] Read more.
Background: as the demand for total joint arthroplasty continues to grow each year, the healthcare burden is expected to increase due to periprosthetic joint infection (PJI). This review article aims to highlight the significance of biofilms in the pathogenesis of PJI and introduce alternative therapies that prevent bacterial adhesion to implants or enhance their eradication when infection occurs. Search strategy: we conducted a bibliographic search in PubMed using the following MeSH terms as follows: “no antibiotic treatment of PJI”, “bacterial biofilm eradication agents”, and “unconventional prevention of PJI”, among others. Most important results: after an initial analysis of the literature, we selected the most significant topics on novel PJI treatment methods and prevention strategies. A second PubMed search highlighted the following therapeutic modalities: the application of hydrogels on implant surfaces, the use of phage therapy, lysostaphin and antimicrobial peptides, the implementation of two-stage debridement, irrigation, implant retention and antibiotic therapy (DAIR), the intra-articular antibiotic infusion, and the use of methylene blue for biofilm eradication. Conclusions: the use of new cement spacers with xylitol, ammonium compounds, or silver nanoparticles is another promising technique to increase the eradication rate in two-stage revision. It is important for professionals to deeply understand the pathogenesis of PJI and the role of biofilms in its development in order to become familiar with these novel techniques that could reduce the burdens on healthcare systems. Full article
(This article belongs to the Special Issue Clinical Management of Prosthetic Joint Infection (PJI))
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13 pages, 221 KiB  
Review
A Narrative Review of Fungal Periprosthetic Joint Infections of the Hip and Knee: Risk Factors, Microbiological Profiles, and Treatment Challenges
by Wojciech Sznajder, Beata Jankowska-Polańska and Wojciech Tański
J. Clin. Med. 2025, 14(1), 206; https://doi.org/10.3390/jcm14010206 - 2 Jan 2025
Viewed by 1130
Abstract
Fungal periprosthetic joint infections (PJIs) are rare but increasingly recognized complications following total joint arthroplasty (TJA). While Candida albicans remains the most common pathogen, non-albicans Candida species and other fungi, such as Aspergillus, have gained prominence. These infections often present with subtle [...] Read more.
Fungal periprosthetic joint infections (PJIs) are rare but increasingly recognized complications following total joint arthroplasty (TJA). While Candida albicans remains the most common pathogen, non-albicans Candida species and other fungi, such as Aspergillus, have gained prominence. These infections often present with subtle clinical features and affect patients with significant comorbidities or immunosuppression. Compared to bacterial PJIs, fungal infections pose unique diagnostic and therapeutic challenges, including biofilm formation, limited antifungal susceptibility, and protracted treatment courses. This narrative review synthesizes current evidence from research articles and review/metanalysis papers, focusing on fungal PJIs. The literature search encompassed publications from 2015 to 2024, identifying key insights on epidemiology, risk factors, microbiological profiles, diagnostic methods, therapeutic strategies, and outcomes. Both classical references and recent studies addressing emerging diagnostic biomarkers and biofilm-active therapies were included. It was shown that C. albicans remains the primary fungal pathogen in PJIs but non-albicans Candida species and other fungi are associated with more complex clinical scenarios, higher recurrence rates, and reduced infection-free survival. Patients commonly exhibit multiple comorbidities, compromised immune status, and previous prosthetic revisions. Diagnosis is complicated by slow-growing organisms and nonspecific inflammatory markers, prompting interest in novel diagnostics such as alpha-defensin, calprotectin, and next-generation sequencing. Two-stage revision arthroplasty, supplemented by prolonged targeted antifungal therapy, is considered the gold standard for chronic infections, although outcomes remain inferior to bacterial PJIs. Emerging strategies, including antifungal-impregnated beads and biofilm-disrupting agents, may improve local infection control. In conclusion, fungal PJIs constitute a challenging clinical entity demanding tailored diagnostic and therapeutic approaches. Further research into standardized diagnostic criteria, optimized antifungal regimens, biomarker validation, and refined surgical strategies is essential. Multidisciplinary collaboration, enhanced patient optimization, and innovative biofilm-directed therapies hold promise for improving outcomes and reducing the burden of fungal PJIs. Full article
(This article belongs to the Special Issue Clinical Management of Prosthetic Joint Infection (PJI))

Other

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11 pages, 1239 KiB  
Systematic Review
The Influence of Tranexamic Acid (TXA) on Postoperative Infection Rates Following Total Hip Arthroplasty (THA)—A Systematic Review
by Radu Prejbeanu, Mihail Lazar Mioc, Eleftherios Tsiridis, Eustathios Kenanidis, Federico Valli, Andrea Pasquini and Bogdan Deleanu
J. Clin. Med. 2025, 14(9), 2910; https://doi.org/10.3390/jcm14092910 - 23 Apr 2025
Viewed by 305
Abstract
Background: Tranexamic acid (TXA) has become a cornerstone in total hip arthroplasty for reducing blood loss and minimizing transfusion requirements. However, its influence on postoperative infection rates, including surgical site infections and periprosthetic joint infections (PJIs), remains a topic of debate. This systematic [...] Read more.
Background: Tranexamic acid (TXA) has become a cornerstone in total hip arthroplasty for reducing blood loss and minimizing transfusion requirements. However, its influence on postoperative infection rates, including surgical site infections and periprosthetic joint infections (PJIs), remains a topic of debate. This systematic review aims to explore the association between tranexamic acid use and infection rates in total hip arthroplasty. Methods: Following PRISMA 2020 guidelines, an electronic search was performed in the PubMed, Scopus, Web of Science, Cochrane, and Epistemonikos databases. A PICO-based question was developed to select relevant studies, which were assessed for quality using the MINORS tool for non-randomized studies and the RoB 2 tool for randomized controlled trials (RCTs). This review critically appraises three studies, including one RCT and two retrospective cohort studies. Results: Of 277 studies identified, 3 met inclusion criteria, totaling 146,227 patients. Findings indicate that tranexamic acid is generally associated with reduced periprosthetic joint infections and surgical site infection rates, with some variability based on administration routes and dosages. Despite these promising results, methodological limitations in the included studies underscore the need for further high-quality research to establish optimal tranexamic acid protocols. Conclusions: In summary, this systematic review indicates that TXA could reduce postoperative infection rates following total hip arthroplasty (THA). Further well-designed randomized controlled trials are required to validate these findings and determine the best dosing and administration strategies. PROSPERO registration: CRD42024589078. Full article
(This article belongs to the Special Issue Clinical Management of Prosthetic Joint Infection (PJI))
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