Jevnikar Benjamin E, Khan Shujaa T, Huffman Nickelas, Pasqualini Ignacio, Surace Peter A, Deren Matthew E, Piuzzi Nicolas S
Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, 44195, USA.
J Clin Orthop Trauma. 2024 Jul 18;55:102496. doi: 10.1016/j.jcot.2024.102496. eCollection 2024 Aug.
Periprosthetic joint infection (PJI) presents a critical challenge in orthopedic care, contributing to significant patient morbidity and healthcare costs. This burden is expected to increase secondary to growing demand for total joint arthroplasty (TJA). Despite the profound significance of PJI, there is currently no universally accepted "gold standard" diagnostic criteria using serum biomarker thresholds; latest criteria fail to differentiate acute infections from chronic or consider time since initial surgery. Furthermore, contemporary PJI treatment, which conventionally requires 2-stage revision surgery in conjunction with rigorous antibiotic treatment, can be particularly taxing on patients. Fortunately, recent years have seen marked evolution in both PJI diagnosis and treatment methods. Contemporary research supports time-dependent serum biomarker thresholds with greater sensitivity and specificity than previously reported, as well as alternative surgical options which may be more suitable for certain patients. The following narrative review aims to describe the significance and pathogenesis of PJI before characterizing current challenges, novel innovations, and the future landscape of PJI diagnosis and management. Here, we spotlight the emerging utility of novel biomarkers and metagenomic next-generation sequencing for diagnosis, advancements in patient-centered surgical outcome prediction tools for PJI risk assessment and prevention, and evolving surgical techniques including 1-stage and a "hybrid" 1.5-stage revision surgeries. Additionally, we explore cutting-edge therapeutic modalities including peptide and bacteriophage-based treatments, intraoperative anti-biofilm gel, the VT-X7 antibiotic pump, and promising immune-based interventions. Ultimately, these advancements hold the potential to revolutionize PJI management, offering hope for improved outcomes and reduced burdens on healthcare systems.
人工关节周围感染（PJI）是骨科护理中的一项严峻挑战，会导致患者出现严重的发病情况并增加医疗成本。由于全关节置换术（TJA）的需求不断增加，预计这一负担将会加重。尽管PJI具有重大意义，但目前尚无使用血清生物标志物阈值的普遍接受的“金标准”诊断标准；最新标准无法区分急性感染与慢性感染，也未考虑初次手术后的时间。此外，传统的PJI治疗通常需要两阶段翻修手术并结合严格的抗生素治疗，这对患者来说可能特别费力。幸运的是，近年来PJI的诊断和治疗方法都有了显著进展。当代研究支持采用具有比先前报道更高敏感性和特异性的时间依赖性血清生物标志物阈值，以及可能更适合某些患者的替代手术选择。以下叙述性综述旨在描述PJI的意义和发病机制，然后阐述当前面临的挑战、新的创新以及PJI诊断和管理的未来前景。在此，我们重点介绍新型生物标志物和宏基因组下一代测序在诊断中的新兴应用、以患者为中心的手术结果预测工具在PJI风险评估和预防方面的进展，以及不断发展的手术技术，包括一期和“混合”1.5期翻修手术。此外，我们还探讨了前沿治疗方式，包括基于肽和噬菌体的治疗、术中抗生物膜凝胶、VT-X7抗生素泵以及有前景的免疫干预措施。最终，这些进展有可能彻底改变PJI的管理方式，为改善治疗效果和减轻医疗系统负担带来希望。
