Biofilm and How It Relates to Prosthetic Joint Infection

PJI is an uncommon but challenging condition to address, in part due to the development of a bacterial biofilm on the orthopedic hardware. The authors present the nuances of PJI in the context of biofilm formation and how it relates to diagnosis, treatment, and prevention of this complex problem. Bacteria in biofilms demonstrate multiple protective mechanisms, including envelopment in an extracellular polymeric substance, diminished metabolic activity, physical sequestration from the host immune system, and antibiotic resistance. Prevention, diagnosis, and treatment are all impaired and eradication often involves implant removal. Investigation into new techniques including implant surface coating, nanotechnology, antimicrobial peptides, and bacteriophages are of the utmost importance as we seek to minimize the harm associated with PJI.