الفهرس 
PATHOGENESISOnly 14 pages are availabe for public view
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Abstract
Periprosthetic joint infection is one of the major complications and etiologies of implant failure after joint arthroplasty the incidence ranged between 1% and 2% of hip arthroplasties (THA) and knee arthroplasties, in the future it is expected that the incidence of revision of prosthetic joint infection will further increased.
Biofilms play an important role in pathogenesis of PJI. Biofilm is a complex structure comprised of microorganisms enveloped in macro-molecules of glycocalyx and other protective structures. Attachment of bacteria to a surface involves cell-to-cell adhesion between micro-organisms and the artificial surface. A majority of PJI are caused by Gram-positive cocci (Staphylococcus aureus and coagulase-negative Staphylococcus). On occasions, Gram-negative bacteria and fungi may also result in PJI. A considerable proportion of PJIs can be polymicrobial.
The diagnosis of periprosthetic joint infection is challenging and relies on a combination of clinical judgment (full history &clinical examination), preoperative and intra-operative diagnostic investigations is usually required for an accurate diagnosis of PJI.
The combination of serology and joint aspiration is adequate for diagnosis of PJI in the majority of cases. In a very select few, in whom PJI is suspected but cannot be confirmed, additional tests such as nuclear imaging may be ordered.
The goal of treating infection associated with a prosthetic joint is a pain-free, functional joint. This can best be achieved by eradication of the infection. Various therapies have been used, including surgical removal of all infected tissue and the implant and a combination of débridement with implant retention and long-term antimicrobial therapy that is active against biofilm microorganisms.
Better outcomes have been reported for two-stage arthroplasty revision for infection. However, one-stage revision arthroplasty remains an attractive alternative option since it requires only one operation.