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Prosthesis
Special Issues
Managing the Challenge of Periprosthetic Joint Infection
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Managing the Challenge of Periprosthetic Joint Infection

A Special Issue of Prosthesis (ISSN 2673-1592) belonging to the section "Orthopedics and Rehabilitation".

Deadline for manuscript submissions: 31 December 2026 | Viewed by 4498

Editors

Dr. Rareş Mircea Bîrluţiu

E-Mail Website
Guest Editor
1. Department 14-Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
2. “Foisor” Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
Interests: bone and joint infections; periprosthetic joint infection; fracture-related infection; surgical site infection prevention; diagnostic biomarkers and microbiology; revision arthroplasty; outcomes research
Special Issues, Collections and Topics in MDPI journals
Dr. Jaime Esteban

E-Mail Website
Guest Editor
Departamento de Microbiología Clínica, Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
Interests: clinical microbiology; biofilms; mycobacteria; implant-associated infections
Special Issues, Collections and Topics in MDPI journals
Dr. Efthymia Giannitsioti

E-Mail Website
Guest Editor
1st Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
Interests: clinical microbiology; biofilms; mycobacteria; implant-associated infections

Special Issue Information

Dear Colleagues,

Periprosthetic joint infection (PJI) remains one of the most challenging complications after arthroplasty, with substantial patient morbidity, health-system burden, and complex decision-making across diagnostics and treatment.

Despite advances in microbiology, imaging, and surgical techniques, we still face critical gaps: early and reliable diagnosis in culture-negative or low-grade infections; optimal use of molecular assays and sonication; choosing between DAIR, one-stage, and two-stage strategies; antibiotic duration and combinations in the era of AMR; and standardized outcome reporting that meaningfully reflects infection control, function, and quality of life.

This Special Issue of Prosthesis focuses on contemporary, pragmatic solutions for the diagnosis and treatment of PJI, bridging orthopedic surgery and infectious diseases. We welcome studies that inform day-to-day clinical choices and implementation: comparative effectiveness across surgical strategies; diagnostic accuracy of novel tests; antimicrobial optimization (including long-acting agents); multidisciplinary pathways; real-world outcomes. Methodological rigor (prospective cohorts, registries, meta-research, consensus methods) and transparent reporting are strongly encouraged.

Suggested themes:

  • Diagnostic standards and innovations: biomarkers, next-generation sequencing, metagenomics, PCR/NGS panels, sonication, imaging, and composite criteria;
  • Surgical strategies: DAIR optimization; one- vs. two-stage revision; spacer concepts; megaprostheses; salvage procedures;
  • Antimicrobial therapy: IV-to-oral switch, long-acting lipoglycopeptides, anti-biofilm combinations, dosing/PK-PD in bone and biofilm, and OPAT models;
  • Difficult pathogens and hosts: MRSA/MRSE, rifampicin resistance, Gram-negative and polymicrobial PJI, fungal PJI, culture-negative PJI, and immunocompromised hosts.
  • Prevention and risk reduction: decolonization, perioperative prophylaxis in AMR settings, laminar flow/OR practices, and host optimization;
  • Outcomes and methodology: core outcome sets, failure definitions, competing-risk analysis, cost-effectiveness, and patient-reported outcomes;
  • Consensus and pathways: ID–orthopedics co-management, multidisciplinary boards, protocolized care, and registry-based quality improvement.
  • Results from Basic Science and Experimental Models research in Bone and Joint Infection.

For this Special Issue, we invite original research, reviews, short communications, technical notes, and consensus statements, as well as case-reports. We look forward to receiving your contributions.

Dr. Rareş Mircea Bîrluţiu
Dr. Jaime Esteban
Dr. Efthymia Giannitsioti
Guest Editors

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 250 words) can be sent to the Editorial Office for assessment.

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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Prosthesis is an international peer-reviewed open access monthly 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 1800 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

  • periprosthetic joint infection
  • bone and joint infection
  • DAIR
  • one-stage revision
  • two-stage revision
  • biofilm
  • molecular diagnostics
  • metagenomics/NGS
  • antimicrobial therapy
  • long-acting antibiotics
  • outcome measures
  • AMR

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Published Papers (4 papers)

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Research

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14 pages, 519 KB  
Article
Diagnostic Performance of Hematological Blood Ratios in Revision Surgery for Periprosthetic Joint Infections: A Retrospective Cohort Analysis of CRP/Hb Ratio, NLR, and MLR
by Diana-Elena Vulpe, Serban Dragosloveanu, Rares-Mircea Birlutiu, Victoria Birlutiu, Radu Josanu, Andrei Larie, Calina Maier, Cristian Scheau, Javad Parvizi and Oana Sandulescu
Prosthesis 2026, 8(6), 57; https://doi.org/10.3390/prosthesis8060057 - 11 Jun 2026
Viewed by 964
Abstract
Objectives: Periprosthetic joint infections represent a serious complication following joint arthroplasty, often leading to significant morbidity, with an economic and social impact on the health system. Timely diagnosis of periprosthetic joint infections remains a major challenge. Our study aimed to investigate the diagnostic [...] Read more.
Objectives: Periprosthetic joint infections represent a serious complication following joint arthroplasty, often leading to significant morbidity, with an economic and social impact on the health system. Timely diagnosis of periprosthetic joint infections remains a major challenge. Our study aimed to investigate the diagnostic value and accuracy of several markers, including the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and C-reactive protein-to-serum-hemoglobin ratio in revision surgery for periprosthetic joint infections. Methods: A total of 251 revision arthroplasty cases, including 137 cases of periprosthetic joint infections and 114 cases of aseptic revision arthroplasty, were included from the time span January 2016 to May 2025. The diagnostic value and accuracy of the C-reactive protein-to-hemoglobin ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio were evaluated using sensitivity, specificity, and receiver operating characteristic (ROC) analysis with area under the curve analysis. Results: The highest diagnostic performance was obtained by the C-reactive protein-to-hemoglobin ratio, yielding an AUC of 0.859 (SE = 0.0263, 95% CI: 0.809–0.899). This ratio also demonstrated a strong discriminative capacity, with a threshold of >0.0667, sensitivity of 80.45%, and specificity of 85.96%. For the neutrophil-to-lymphocyte count ratio and monocyte-to-lymphocyte count ratio, we obtained an AUC of 0.615 (95% CI: 0.551–0.676) and 0.620 (95% CI: 0.556–0.680), respectively, demonstrating lower sensitivity and specificity than the C-reactive protein-to-hemoglobin ratio. Conclusions: The C-reactive protein-to-hemoglobin ratio demonstrated better diagnostic strength in detecting periprosthetic joint infections, with superior sensitivity and specificity compared to the neutrophil-to-lymphocyte count ratio and monocyte-to-lymphocyte count ratio. Our findings offer new insights into the accurate and early diagnosis of periprosthetic joint infections in cases requiring revision surgery and suggest incorporating these new biomarkers and ratios into the diagnostic algorithm. Future large-scale studies are further needed to validate these results and facilitate their clinical use. Full article
(This article belongs to the Special Issue Managing the Challenge of Periprosthetic Joint Infection)
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28 pages, 4228 KB  
Article
Bactericidal Titanium Oxide Nanopillars for Intersomatic Spine Screws
by Mariano Fernández-Fairén, Luis M. Delgado, Matilde Roquette and Javier Gil
Prosthesis 2026, 8(1), 4; https://doi.org/10.3390/prosthesis8010004 - 26 Dec 2025
Viewed by 1855
Abstract
Background: Postoperative infections remain a major complication in spinal surgeries involving intersomatic screws, often compromising osseointegration and long-term implant stability. Questions/Purposes: This study evaluated a nanotextured titanium oxide surface with nanopillar-like morphology designed to reduce bacterial colonization while preserving mechanical integrity [...] Read more.
Background: Postoperative infections remain a major complication in spinal surgeries involving intersomatic screws, often compromising osseointegration and long-term implant stability. Questions/Purposes: This study evaluated a nanotextured titanium oxide surface with nanopillar-like morphology designed to reduce bacterial colonization while preserving mechanical integrity and promoting bone integration. Methods: Ti6Al4V screws were studied in three batches: control, passivated with HCl and acid mixture treatment to obtain nanotopographies on the surfaces. To create the nanotopographies, the screws were treated with a 1:1 (v/v) sulfuric acid–hydrogen peroxide solution for 2 h. Surface morphology, roughness, wettability, and surface energy were analyzed by SEM, confocal microscopy, and contact angle measurements. Corrosion and ion release were assessed electrochemically and by ICP-MS, respectively. Mechanical behavior, cytocompatibility, mineralization, and antibacterial efficacy were evaluated in vitro. Osseointegration was analyzed in rabbit tibiae after 21 days by histology and bone–implant contact (BIC). Results: The treatment produced uniform nanopillars (Ra = 0.12 µm) with increased hydrophilicity (49° vs. 102° control) and higher surface energy. Mechanical properties and fatigue resistance (~600 N, 10 million cycles) were unaffected. Corrosion currents and Ti ion release remained low. Nanopillar surfaces enhanced osteoblast adhesion and mineralization and reduced bacterial viability by >60% for most strains. In vivo, Bone Index Contact (BIC) was higher for nanopillars (52.0%) than for HCl-treated (43.8%) and control (40.1%) screws, showing a positive osseointegration trend (p > 0.005). Conclusions: The proposed acid-etching process generates a stable, scalable nanotopography with promising antibacterial and osteogenic potential while maintaining the alloy’s mechanical and chemical integrity. Clinical relevance: This simple, scalable, and drug-free surface modification offers a promising approach to reduce postoperative infections and promote bone integration in spinal implants. Full article
(This article belongs to the Special Issue Managing the Challenge of Periprosthetic Joint Infection)
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Review

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18 pages, 1034 KB  
Review
Aspects of the Pathogenesis of Skin Complications in the Stump–Prosthesis System in Dynamics: The Role of Bacterial and Mycological Dysbiosis
by Denis V. Shcherbakov, Evgeny E. Achkasov, Ekaterina A. Shashina, George V. Nesterov, Alina I. Lezinova, Tatyana M. Khodykina, Nina A. Ermakova and Oleg V. Mitrokhin
Prosthesis 2026, 8(8), 88; https://doi.org/10.3390/prosthesis8080088 - 17 Aug 2026
Viewed by 639
Abstract
Background: Lower limb exoprostheses often lead to stump dermatological pathologies. The mechanisms by which mechanical microtraumas progress to non-healing ulcerative defects due to dysbiosis remain poorly understood. The objective of this study was to analyze mechanical, inflammatory, and infectious stump skin complications and [...] Read more.
Background: Lower limb exoprostheses often lead to stump dermatological pathologies. The mechanisms by which mechanical microtraumas progress to non-healing ulcerative defects due to dysbiosis remain poorly understood. The objective of this study was to analyze mechanical, inflammatory, and infectious stump skin complications and justify the role of bacterial and mycological dysbiosis in blocking tissue regeneration. Methods: A critical narrative review guided by SANRA principles was conducted (PubMed/Scopus, 1980–2026). Data were extracted with a structured query focusing on amputation stumps, prosthetic interfaces, and skin/microbiological complications (dysbiosis, biofilms, and inflammatory markers). Evidence was graded using predefined clinical matrices and integrated through structured evidence collations to synthesize stump–prosthesis pathogenesis. The PRISMA method was not applied due to study heterogeneity. Results: Skin damage dynamics were categorized into three stages: adaptation (up to 12 months), chronic reactive changes (12–24 months), and late proliferative-infectious destruction (>24 months). The sealed liner space creates 100% humidity and alkalization (pH > 6.5). This causes a mycological shift, where resident Malassezia spp. lose dominance to invasive Candida albicans and non-dermatophyte molds (Aspergillus spp., Fusarium spp.). These pathogens form polymicrobial biofilms with Staphylococcus aureus. At the molecular level, delayed regeneration is driven by “frustrated phagocytosis”: macrophages, unable to engulf large fungal hyphae, continuously release reactive oxygen species and enzymes, trapping the wound in the inflammatory phase. Excessive matrix degradation and suppressed angiogenic factors further block epithelialization. Conclusions: The skin under a prosthesis socket forms a unique pathological biotope. Successful regeneration requires preventive mycobiota correction and targeted management of biophysical parameters (pH, humidity) within the “skin–liner” interface. Full article
(This article belongs to the Special Issue Managing the Challenge of Periprosthetic Joint Infection)
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Other

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11 pages, 6637 KB  
Case Report
Progressive Structural Failure in Complex Prosthetic Joint Infection Followed by Amputation
by Alejandro Rodríguez-Bobadilla, Andrés Pinzón-Susa, Esteban Hernández-Alfonso, Liseth Katherine Peralta, Pedro Brotons-de Los Reyes and Carolina Firacative
Prosthesis 2026, 8(9), 94; https://doi.org/10.3390/prosthesis8090094 - 10 Sep 2026
Viewed by 256
Abstract
Background: Prosthetic joint infections (PJI) are complex complications of arthroplasty. Detailed sequential polymicrobial infection during long clinical courses, with multiple interventions and sustained antibiotic pressure, has been described sparingly. Methods: We present a case of a 78-year-old woman with various comorbidities, [...] Read more.
Background: Prosthetic joint infections (PJI) are complex complications of arthroplasty. Detailed sequential polymicrobial infection during long clinical courses, with multiple interventions and sustained antibiotic pressure, has been described sparingly. Methods: We present a case of a 78-year-old woman with various comorbidities, including type 2 diabetes mellitus and grade I obesity (body mass index of 31.6), who developed an early PJI after total knee arthroplasty, followed by amputation. Results: Despite serial surgical procedures and antimicrobial therapies, the patient had progressive structural failure in a complex polymicrobial PJI. Therefore, above-knee amputation was required due to reconstructive failure. During the 23-month clinical course, infections caused by six distinct bacteria, some of which were resistant and associated with intramedullary osteomyelitis, were reported at different stages. Conclusions: This case illustrates the evolution and challenging complications of a rare yet dynamic process that developed under selective surgical and antimicrobial pressure. Early recognition of host, tissue, and microbial factors is crucial to achieving optimal PJI outcomes. Full article
(This article belongs to the Special Issue Managing the Challenge of Periprosthetic Joint Infection)
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