Prevention and antibiotic therapy of hip periprosthetic joint infections

Periprosthetic joint infections (PJI) are a tremendous complication of total hip arthroplasty (THA) and cause substantial functional loss, morbidity and mortality. The aim of this narrative review was to summarize evidence regarding strategies to prevent PJI and to provide readers with the key concepts underlying antibiotic therapy management in PJIs. A literature search was performed using PubMed and Cochrane Library databases from the earliest date possible up to March 2021. Included studies regarded all of the following: 1) prevention of PJI after total joint arthroplasty (TJA); 2) focus on screening for Staphylococcus aureus carriers and decolonization; 3) focus on perioperative antibiotic prophylaxis; and 4) antibiotic therapy in THA, focusing on appropriate start time, agent choice and duration. PJIs prevention should rely on a combination of pre-, intra- and postoperative interventions. Overall, evidence regarding S. aureus screening and decolonization and perioperative antibiotic prophylaxis shows significant reduction of surgical site infection (SSI) risk with these interventions. Clinical data about the best type, timing and duration of antibiotic therapy in PJIs are scarce and based on low quality evidence. They globally lead to withhold antibiotic therapy until surgical debridement and microbiological sampling, start empiric antibiotic therapy and tailor it after microbiological results, and early switch to oral therapy. A combination strategy including patient decolonization and antibiotic prophylaxis is of paramount importance for hip PJIs prevention. Antibiotic therapy is complementary to surgical treatment of PJIs and should be individualized based on host, pathogen and surgery-related factors.