Periprosthetic Joint Infection: A Multifaceted Burden Undermining Arthroplasty Success

Abstract

Despite advancements in surgical techniques and implant designs, Periprosthetic joint infection (PJI) continues to be one of the commonest and most devastating causes of failure in total joint arthroplasty. PJIs are associated with significant morbidity and mortality, placing a multifactorial burden on patients, caregivers, surgeons, hospitals, health systems, and economies. The incidence of PJI ranges from 0.5% to 2.3% based on current literature. Mortality rates in PJI subsequent to a primary total hip arthroplasty (THA) range from 4% to 8% after one year. The common treatment for PJI is a two-stage revision THA, which itself is associated with significant morbidity and mortality. The economic burden of PJI is substantial, with treatment costs 3 to 5.6 times higher than primary THA. Patients with PJI experience inferior hip function, lower health-related quality of life scores, and higher odds of developing new onset depression. PJI's negatively impacts on a patient's capacity to work and conduct everyday activities. Orthopaedic surgeons also face significant psychological stress due to the challenges in managing PJI, including feelings of incompetence, insecurity, and frustration. Continued research and innovation are essential to optimize THA outcomes and reduce the need for revision surgeries. Improved prevention strategies, multidisciplinary cooperation, and comprehensive care and support for both patients and surgeons are crucial. It is paramount that every orthopaedic surgeon remains cognisant of this complication to institute better prevention strategies, promote better multi-disciplinary cooperation and enhance patient pre-operative care.