Periprosthetic joint infection in the knee — Criteria for the management of PJI

The diagnosis and management of periprosthetic joint infection (PJI) is complex and involves multiple specialities. As such, it has been recommended that the management of patients with PJI should be performed by well-organised multi-disciplinary teams, interacting across regions as networks.

At the International Consensus Meeting in Philadelphia in 2018, the debate demonstrated differences in practices worldwide. This led to the UK surgeons establishing a group of orthopaedic and microbiologic specialists that would be able to focus on the particular challenges that the UK faces (the United Kingdom Prosthetic Joint Infection (UKPJI) group).

The UKPJI group have been working collaboratively to increase the knowledge and understanding of the treatment of PJI in the UK. At the 2019 UKPJI meeting, there was a session on the criteria for the management of PJI, which is summarised in this review article.

The principles of PJI management start with ensuring that there is an appropriate team available with suitable experience. It is recommended that specialists are involved from the outset, as early senior decision making is key. Consideration for prompt referral through local clinical network infrastructures is needed. Hospitals treating PJI must have appropriate staff (trained surgeons, microbiologists and rehabilitation teams) with suitable facilities and equipment (theatre facilities, intensive care or high dependency care availability and prostheses).

At all stages, it is also important that the patient’s well-being and psychological health must be considered. Patients can be signposted towards support services where required.

Once a PJI diagnosis has been made, an appropriate management plan is required. This review discusses the criteria for these treatment options.

The main treatment options include:

• 1.
  Arthroscopy
• 2.
  Debridement, antibiotics and implant retention (DAIR)
• 3.
  One stage revision
• 4.
  Two stage revision
• 5.
  Conservative management or long-term infection suppression
• 6.
  Salvage procedures