title: Multi-disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee.
abstract: Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Getzlaf
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Lewallen
authors.affiliation: Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Hilal M
authors.initials: HM
authors.lastname: Kremers
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.|Department of Biomedical Engineering and Physiology, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Dakota L
authors.initials: DL
authors.lastname: Jones
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Carolina A
authors.initials: CA
authors.lastname: Bonin
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Amel
authors.initials: A
authors.lastname: Dudakovic
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Roman
authors.initials: R
authors.lastname: Thaler
authors.affiliation: Reconstructive Research and Development, Stryker Orthopedics, 325 Corporate Drive, Mahwah, New Jersey 07430.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Cohen
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: David G
authors.initials: DG
authors.lastname: Lewallen
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905.
authors.forename: Andre J
authors.initials: AJ
authors.lastname: van Wijnen
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*
keywords: arthroplasty; implant; individualized medicine; infection; joint