The Paradox of Prosthetic Joint Infection and the Microbiome: Are Some Bacteria Actually Helpful?

Periprosthetic joint infection (PJI) is a potentially catastrophic complication of total joint arthroplasty of the lower extremity. PJI is associated with significant burden of illness and economic cost. There are a number of well-established modifiable risk factors for PJI. Myriad perioperative protocols are used with the intent of reducing the incidence of PJI. However, it remains unclear why infections occur despite correction of modifiable risk factors and/or adherence to prophylactic protocols. There is emerging evidence that the microbiome—the diverse population of commensal microorganisms that inhabit the human body—may play a role in the pathogenesis of musculoskeletal infections. The impact of the microbiome on PJI warrants further investigation and may change how we conceptualize, prevent, and treat PJI.