Periprosthetic Joint Infections in Total Knee Arthroplasty

It is with immense pleasure that I am writing foreword for this focused issue of the Journal of Knee Surgery. The special focus section in this issue includes four important review articles cove diverse controversial and current topics focusing on periprosthetic joint infections (PJI) covering all related aspects from biofilm formation to diagnosis and treatment. The first article reviews the diagnostic and management challenges posed by the formation of biofilms in the setting of PJI. The features of biofilms, preventative strategies, methods of eradication, and treatment protocols are described in this work. Furthermore, based on the content covered, the other articles fall into the following three sections:

Diagnosis of PJI: Musculoskeletal Infection Society (MSIS) modified by International Consensus Meeting (ICM) with its limitations is the most accepted criteria till date. Several biomarkers have been investigated for diagnosis of infection and serum D-Dimer has emerged as a promising diagnostic marker for PJI. One of the articles summarizes the current evidence on serum D-Dimer as a biomarker of infection and proposes the future directions for its role in PJI diagnosis.

Prevention of PJI: With respect to the antibiotic prophylaxis, it is also unclear if dual antibiotic therapy is more effective than the single–antibiotic therapy to diminish postoperative infection after total knee arthroplasty (TKA). The article on this matter analyses the current literature regarding the infusion of dual prophylactic antibiotics in TKA.

Treatment of PJI: Antibiotics are the pillars of the treatment for PJI. One review article underlines some controversial subjects including the route and extension of prophylactic antibiotics. This article discusses the use of extended oral antibiotics after revision TKA.

This symposium covers a broad spectrum of issues related to PJI. I hope that the works presented here serve as a great source of information for the entire adult reconstruction community.