Periprosthetic joint infection and medico-legal dilemmas: algorithmic approach to diagnosis and strategies for prevention and risk management

Cases of periprosthetic hip and knee infections are constantly increasing with a parallel increase in legal disputes between patients-surgeons-hospitals. Although it is known that scientific and technological progress to date is not such as to eliminate the septic complications of arthroplasties, in the medical-forensic field it is know that the infection may be attributable to surgeon errors and/or hygienic-sanitary measures or technological-organizational deficiencies of the hospital structure. By referring to a scheme of clinical, hygienic, and organizational procedures, extracted from the orthopedic scientific literature, it is possible to verify whether in cases of periprosthetic joint infection there is a health liability (medical or of the structure) due to insufficient attention to infection risk factors and/or due to lack of related containment actions. Periprosthetic joint infection (PJI) is still one of the most feared and challenging complications. The aim of this narrative review is to identify possible periprosthetic joint infection prevention strategies which, in our opinion, should be based on a combination of pre-, intra-, and postoperative interventions, aimed at containing the risk of infectious complications in prosthetic surgery of hip and knee.