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International Consensus Group on Periprosthetic Joint Infection

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Periprosthetic joint infection (PJI), with its disastrous implications, continues to challenge the orthopaedic community. Practicing orthopaedic surgeons have made great efforts to minimize surgical site infection (SSI). Although high-level evidence may support some of these practices, many are based on little to no scientific foundation. This results in wide variation across the globe for prevention and management of PJI. To address this, The International Consensus Meeting on Periprosthetic Joint Infection was organized. Delegates from disciplines including orthopaedic surgery, infectious disease, and many others participated. The process of generating the consensus has spanned 10 months. Over 3,500 relevant publications were evaluated by 400 delegates from 58 countries and over 100 societies, who have come together to reach consensus about practices that lack higher level of evidence.

This consensus document has been developed using the Delphi method under the leadership of Dr. Cats-Baril, a world-renowned expert in consensus development. The consensus process was designed to include many participants, allow participation in multiple forums, and provide a comprehensive review of the literature. Covered topics included the following: mitigation and education on comorbidities associated with increased SSI/PJI, perioperative skin preparation, perioperative antibiotics, operative environment, blood conservation, prosthesis selection, diagnosis of PJI, wound management, spacers, irrigation and debridement, antibiotic treatment and timing of reimplantation, one-stage versus two-stage exchange arthroplasty, management of fungal or atypical PJI, oral antibiotic therapy, and prevention of late PJI. Every consensus statement has undergone careful scrutiny by both subject matter experts and generalists to ensure that its implementation will indeed lead to improvement of care for patients. Based on this process, the following consensus statements were developed.