Prevention of periprosthetic joint infection: pre- and intraoperative considerations.

Total joint arthroplasty (TJA) is the ultimate treatment for degenerative joint disease. For the majority of patients, it leads to regained function and improved quality of life. By 2030, the total number of primary total knee arthroplasty (TKA) procedures performed annually in the United States is expected to reach nearly 3.48 million, a 673% increase from the number performed in 2005. Furthermore, the demand for total hip arthroplasty (THA) is expected to grow by 174%, or 572,000 procedures annually, and approximately 4 million TJAs are expected to be performed annually.1 Similar to other medical interventions, TJA is accompanied by some complications. Periprosthetic joint infection (PJI) is a rare but challenging complication after TJA. Periprosthetic joint infection is considered the primary reason for revision in TKA and the tertiary reason for revision in THA.2,3 It can occur any time after the surgery and its diagnosis is challenging.4,5 Periprosthetic joint infection also has a huge financial impact on the health care system. In the United States, revision because of infection cost approximately $320 million in 2001, increased to $566 million in 2009, and is expected to exceed $1.62 billion by 2020.6 Hence, prevention of PJI is mandatory.7