Better researcher, clinician interactions may aid innovations in PJI treatment
Eliminating periprosthetic joint infection as a disease process is a “dream,” a presenter at the Orthopaedic Research Society Annual Meeting said, noting the orthopedic community will produce novel innovations that can improve patient care.
The increasing infection rates associated with total hip arthroplasty and total knee arthroplasty pose clinical challenges and are of major concern to orthopedic surgeons and researchers, Matthew J. Dietz, MD, of West Virginia University, said. “We need to improve our ability to address these challenging clinical situations. But, hopefully, through positive interactions, we can bridge that valley of death that so often stifles bringing novel innovations from the bench to the bedside and together we can improve our ability to care for these patients.”
The Orthopaedic Research Society can work to bridge the gap from bench to bedside regarding PJI and improve the overall understanding of the microorganisms that cause these clinical challenges, Dietz said.
One of the areas in which Dietz said improvements can be made is THA and TKA infection rates. He noted the current rates are not much better than those in Sir John Charnley’s day.
Through surgical technique, OR environment and patient care changes, “[Charnley] demonstrated a reduction in infection rates from 9% to 1.3%. However, over the next 40-plus years, we have only seen minimal improvements in our reported infection rates,” Dietz said.
In support of that statement, he cited a registry review study by Bryan D. Springer, MD, and colleagues that showed PJI rates from 2010 to 2015 “ranged from 0.79% to 1.3% and all burdens of infection had increased over those reported in the previous 2 years. While infection remains one of the top indications for revision, both in the United States and internationally, this is humbling when we look at our experiences from the past,” Dietz said.
Dietz also discussed research and trends with the potential to drive improvements in the area of PJI, particularly concerning use of one-stage vs. two-stage revisions for PJI. The efficacy of one-stage revision for PJI is approaching that of two-stage revision and it is less invasive, he said.
“We see a growing interest in a possible shift in the paradigm in the United States to parallel our European colleagues. We are currently awaiting the results of two separate randomized, controlled studies comparing the two-stage and single-stage exchanges,” Dietz said.
Meanwhile, attention should be focused on improving the least morbid options of debridement, irrigation and retention of implants, and dilution and washes, he said.
“Therefore, we need better adjuvants, whether it’s through better washes, phage therapy or biophysical disruption. We need more weapons in our arsenal. We need to improve our surgical techniques so that 10 years from now, we can say that our treatment success is better than it stands today,” Dietz said. “We need to find better ways to deliver our therapeutics that are tolerated safely by our patients.”