Second-Generation Molecular Diagnostics and Strategies for Preventing Periprosthetic Joint Infections

Abstract

Bacteria are highly successful organisms, with biofilms enhancing their ability to effectively mutate to acquire drug resistance (Harbottle et al. 2006; Høiby et al. 2010; Jolivet-Gougeon et al. 2011). Fossil records show that bacteria have been using biofilm survival mechanisms for over three billion years (Hall-Stoodley et al. 2004; Tice and Lower 2004). The extensive history of bacteria in perfecting biofilms has resulted in a long record of success for bacteria in natural ecosystems, and to problems for clinicians in eradicating biofilm infections.

Orthopedists need to understand that bacterial biofilms have evolved to become successful survivors, displaying aggressive and resistant qualities. Biofilms are often difficult to detect using traditional diagnostic techniques. In addition, the inherent resistance of biofilms to antimicrobials has made chronic bacterial infections a major problem facing orthopedic surgeons. Periprosthetic joint infections (PJIs) occur in 1–2% of primary total knee and hip arthroplasties and 3–9% of revisions (Blom et al.; Ridgeway et al. Wilson et al. Mortazavi et al. ). Although only a minority of arthroplasties are complicated by PJI, current treatment of established PJI biofilms in orthopedics requires extensive and often debilitating surgeries. Consequently, orthopedic infection management should focus on early recognition of infection and on strategies to reduce infection risk before patients come into the operating room.