Epidemiology and prevention of prosthetic joint infection

Background. Prosthetic joint infection (PJI) is challenging for patients and orthopedic surgeons and represents a great economic burden to the health care system. The growing number of primary and revision arthroplasty procedures in an aging society with demographic changes will increase the number of PJIs in the future. Aim. This article presents an overview of the epidemiology and prevention of PJI. Method. A selective literature review was performed focusing on evidence-based epidemiology, risk factors, and prevention of PJI. Results. The total number of primary arthroplasty and septic revision procedures is increasing. The incidence of PJI is constant, although surgical techniques have improved over the years, with a multitude of possible preventive procedures for use before surgical treatment. This is most likely due to the increasing comorbidities and individual risk factors of the patient. Both endogenous and exogenous risk factors are known to be associated with PJI. Endogenous risk factors include diabetes, obesity, immunosuppression, oncological diseases, rheumatoid arthritis, previous or chronic infections, and bacteriuria. Exogenous risk factors include the extended duration of the operation, blood transfusion, and hypothermia. However, the facilities in the operating theatre or the use of iodine-impregnated incision drape seem to have no influence on the incidence of PJI. Prospect. The increasing number of arthroplasty procedures and the static incidence of PJI will result in an increase in the total number of PJIs in the next few years. In particular, the costs to the health care system of the treatment of PJI will emphasize further the need for the prevention of PJI. Individual risk factors should be optimized before arthroplasty requiring a close cooperation between the general practitioner and the orthopedic specialist.