Contemporary Management and Emerging Therapies in Periprosthetic Joint Infection

Authors

• Nathan Gunter, University of LynchburgFollow

Specialty

Orthopedics

Abstract

Periprosthetic joint infection (PJI) is one of the most devastating complications following total joint arthroplasty. It is associated with functional disability, multiple surgical interventions, extended hospital stays, and increased mortality. This manuscript synthesizes contemporary evidence on medical advancements and surgical management strategies for PJI, organizing approaches to treatment based on infection chronicity, pathogen type, and patient host factors. These strategies include debridement, antibiotics, and implant retention (DAIR), one-stage revision, two-stage revision, and emerging biofilm-targeted therapies. As total joint arthroplasty procedures continue to rise, the burden of PJI remains substantial despite advancements in surgical techniques and technology. Management strategies remain complex and require individualized patient-dependent decision-making based on the time frame of infection, pathogen type, host factors, and implant stability. For acute PJI, DAIR is an effective prosthesis sparing approach when performed early in appropriately selected patients, offering shorter hospital admissions and decreased healthcare costs. In chronic PJI, two-stage revision has historically been the preferred approach; however, growing evidence supports one-stage revision as a comparative alternative in select patients, offering similar reinfection rates with reduced burden and quicker recovery. Novel biofilm-targeted therapies, including enzymatic degradation, phage therapy, and antimicrobial implant coatings, may further refine treatment strategies. Standardized diagnostic criteria, clearer definitions of treatment success, and research are necessary to establish treatment algorithms and optimize patient outcomes in the management of PJI.

Recommended Citation

Gunter N. Contemporary Management and Emerging Therapies in Periprosthetic Joint Infection. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).