Prosthetic joint infections—a need for consolidation?

During the last couple of years several articles on prosthetic joint infection (PJI) have been published in Acta Orthopae-dica, ranging for example from papers on experimental studies , new surgical techniques, diagnostic modalities, risk factors , retrospective studies on treatment results, and registry This probably refl ects that PJI is the most important complication of prosthetic surgery. This issue of Acta Orthopaedica presents 4 new studies on different aspects of PJI. Zhu et al. (2016) compared data on the rate of PJI reported to the New Zealand Joint Registry (NZJR) with the " true " rate of PJI, identifi ed by audit of hospital records (discharge and operation codes). Less than two-third of PJIs were reported to the NZJR. Similar rates of underestimation of PJI in arthroplasty registries have also been reported from the Nordic countries (Witsø 2015). 2 other articles in this issue of Acta Orthopaedica present data on the results of surgical treatment of PJI (Janssen et al. 2016, Lindberg-Larsen et al. 2016). The fi rst one is a registry study from Denmark on 105 partial and 215 two-stage revisions, and the other one is a retrospective study from the Netherlands, presenting the results of 120 two-stage revisions performed at one center. It is rather impressive that the group from the Netherlands has presented more or less complete data on patients operated over a time span of 25 years. However , the fact that such a long time is needed to study treatment results is of course also a problem. A randomized clinical trial (RCT) should have been the ideal approach when comparing different surgical treatments of PJI, such as 1-stage and 2-stage prosthetic revision. Until now, no such study has been performed (Beswick et al. 2012, Strange et al. 2016). To get a suffi cient number of patients is a major problem when conducting RCTs in orthopedic surgery (Bernstein et al. 2003). In the near future we will hopefully have the results of random-ized multicenter trials comparing 1-and 2-stage revision of infected prostheses (Strange et al. 2016). In addition, randomized trials comparing the results of different antibiotic regimes in cases of PJI have been diffi cult to conduct. One such example was the study on rifampin by Zim-merli et al. (1998). The study has been cited more than 560 times (Scopus), and has had a large impact on orthopedic surgeons and infectious disease specialists. The study compared …