LISBON, Portugal — The evolution that is underway within periprosthetic joint infection will depend on better understanding the current and future roles of microbiomes, immune modulation, genetic science and biofilm disruption in regard to this problem, according to Javad Parvizi, MD, FRCS.
Parvizi gave the EFORT Erwin Morscher Honorary Lecture at the EFORT Annual Congress, here.
“The future will have to be different to address these issues,” he said.
Furthermore, those in orthopedic research who are participating in this evolution “need to learn from the experience of others,” such as researchers in oncology and leaders in other medical specialties who have made inroads in the clinical application of immunotherapy, Parvizi said.
In terms of approaches with real promise in orthopedic infection application, he discussed his group’s work at Rothman Orthopaedic Institute in Philadelphia, as well as some strategies and infection-fighting remedies that show potential.
“There are a lot of new discoveries, and I think the game will definitely change in the future for periprosthetic joint replacement management,” Parvizi told Healio.com/Orthopedics.
Parvizi and colleagues have done work in terms of biofilm disruption and they have developed antiseptic solutions in the lab that have been effective in disruption of biofilm.
“Joint infections with mature biofilms are difficult to eradicate,” he said, noting these solutions could “change the game” when it comes to [debridement, antibiotics and implant retention] DAIR procedures.
“We also have had some great discoveries related to genomics in that we found the majority of infections in orthopedics are caused by multiple organisms. This is a multicenter study that will be presented in future meetings, and the polymicrobial nature of the infection is such that if you ignore other organisms existing, this could lead to a later infection. So, all the failures we see after two-stage exchange arthroplasty, for example, could potentially be prevented if we also take care of the organisms that were there as bystanders and perhaps treat them, as well,” said Parvizi, who is an Orthopedics Today Editorial Board Member. – by Susan M. Rapp
Parvizi J. Periprosthetic joint infection: Orthopaedics on the verge of an evolution. Presented at: EFORT Annual Congress; June 5-7, 2019; Lisbon, Portugal.
Disclosure: Parvizi reports he is a paid consultant for Zimmer Biomet, ConvaTec, TissueGene, CeramTec and Ethicon; has stock options with Parvizi Surgical Innovations, Hip Innovation Technology, CD Diagnostics, CorenTec, Alphaeon, Joint Purification Systems, Ceribell, MedAp, MicroGenDx, Cross Current Business Intelligence, Invisible Sentinel, Physician Recommended Nutriceuticals and Intellijoint; and receives royalties from CorenTec, Datatrace, Elsevier, Jaypee, SLACK Incorporated and Wolters Kluwer.