Medicinal, Psychological, and Health Research Journal (MPHRJ)

Systematic Review of Bacterial Pathogens Associated with Prosthetic Joint Infection After Total Knee Arthroplasty

Document Type : Systematic Review

Authors

Alireza Aghili 1
Sina Najafi 2

1 Assistant Professor of Orthopaedics, Department of Orthopedics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Infectious Disease, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

https://doi.org/10.22034/mphrj.2026.587090.1105
Abstract
Introduction: Prosthetic joint infection (PJI) remains one of the most serious complications following total knee arthroplasty, leading to substantial morbidity, repeated surgical procedures, and increased healthcare burden. These infections are primarily driven by bacterial colonization and biofilm formation on implant surfaces. Given the variability in reported causative microorganisms, the aim of this study was to systematically review the literature to identify the bacterial pathogens most commonly associated with PJI after total knee arthroplasty.

Material and methods: This systematic review followed PRISMA guidelines to identify bacterial pathogens associated with prosthetic joint infection after total knee arthroplasty. Studies were retrieved from PubMed, Web of Science, ScienceDirect, and Google Scholar using structured keywords. Two reviewers independently screened articles, and methodological quality of eligible observational studies was assessed using the Joanna Briggs Institute appraisal tools.

Results: Across four published case reports (n = 4), Ruminococcus/Mediterraneibacter gnavus was implicated in prosthetic joint infection (25%), deep surgical site infection (25%), bacteraemia (25%), and septic arthritis (25%), predominantly in elderly or immunocompromised patients. Identification relied on MALDI-TOF and/or 16S rRNA sequencing in all cases (100%), and favorable clinical outcomes were achieved with combined surgical management and targeted antibiotic therapy in the majority of reported infections.

Conclusion: Mediterraneibacter gnavus should be recognized as a rare but clinically significant opportunistic pathogen capable of causing orthopedic and systemic infections. Accurate diagnosis depends on advanced microbiological techniques, and outcomes appear favorable with timely surgical intervention and targeted antimicrobial therapy. Increased awareness may facilitate earlier detection and appropriate management.

Graphical Abstract

Systematic Review of Bacterial Pathogens Associated with Prosthetic Joint Infection After Total Knee Arthroplasty

Keywords

Mediterraneibacter gnavus
prosthetic joint infection
anaerobic bacteria
MALDI-TOF mass spectrometry
Subjects
[1]       Ameli kalkhoran, S.M, Rabiei, K, Seyed Alizadeh, SM, Heravi, HM, Rouzpeykar, Y, (2022), Analyzing Impact of Intellectual Capital on Business Performance Using Structural Models Based on Customer Knowledge Management, Discrete Dynamics in Nature and Society, 7453565
[2]    Chaichana, K. L., Bydon, M., Santiago Dieppa, D. R., et al. (2014). Risk of infection following posterior instrumented lumbar fusion for degenerative spine disease in 817 consecutive cases. Journal of Neurosurgery: Spine, *20*(1), 45–52.
[3]    White, A. J., Fiani, B., Jarrah, R., et al. (2022). Surgical site infection prophylaxis and wound management in spine surgery. Asian Spine Journal, *16*(3), 451–461.
[4]    Kobayashi, Y., Inose, H., Ushio, S., et al. (2020). Body mass index and modified Glasgow prognostic score are useful predictors of surgical site infection after spinal instrumentation surgery: A consecutive series. Spine, *45*(3), E148–E154.
[5]    Shen, C. J., Miao, T., Wang, Z. F., et al. (2019). Predictive value of postoperative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery. International Immunopharmacology, *74*, Article 105705.
[6]    Walter, G., Vernier, M., Pinelli, P. O., et al. (2014). Bone and joint infections due to anaerobic bacteria: An analysis of 61 cases and review of the literature. European Journal of Clinical Microbiology & Infectious Diseases, *33*(8), 1355–1364.
[7]       NazarI, M. Akhlaghi, F. Pourfathi Nematabad, H. (2025), Comparison of Postoperative nausea and vomiting prevalence in patients with routine NPO and NPO with clear fluids 2 hours before cataract surgery, Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1, 132-139
[8]       Albuzyad, S. S. and Jawad, M. K. (2025). A Systematic Review of Radiology and Radio Oncology Evaluations in Patients with Thoracic and Pelvic Cancers based on Radiological Images. Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(1), 1-11.
[9]    Hattori, M., & Taylor, T. D. (2009). The human intestinal microbiome: A new frontier of human biology. DNA Research, *16*(1), 1–12.
[10] Hall, A. B., Yassour, M., Sauk, J., et al. (2017). A novel Ruminococcus gnavus clade enriched in inflammatory bowel disease patients. Genome Medicine, *9*, Article 103.
[11] Tristancho Baró, A., Viñeta Valdelvira, V., Rezusta, A., & García Lechuz, J. M. (2024). Prosthetic joint infection caused by Mediterraneibacter gnavus following total knee arthroplasty: Challenges in anaerobic bacteria identification. BMC Infectious Diseases, *24*(1), Article 753.
[12] Solans Lopez, M. C., Sanchez Somolinos, M., Igualada Blazquez, C., et al. (2023). Ruminococcus gnavus, an unusual cause of surgical site infection following vertebral posterior instrumentation: A case report. Journal of Spine Surgery, *9*(1), 102–108.
[13] Hioki, T., Kataoka, K., & Mutoh, Y. (2023). Ruminococcus gnavus bacteraemia showing morphological diversity on Gram staining: A case report and literature review. Access Microbiology, *5*(6), Article acmi000442.
[14] Titécat, M., Wallet, F., Vieillard, M. H., Courcol, R. J., & Loïez, C. (2014). Ruminococcus gnavus: An unusual pathogen in septic arthritis. Anaerobe, *30*, 159–160.
[15] Lagacé-Wiens, P. R., Adam, H. J., Karlowsky, J. A., et al. (2012). Identification of blood culture isolates directly from positive blood cultures by matrix-assisted laser desorption ionization–time of flight mass spectrometry and a commercial extraction system: Analysis of performance, cost, and turnaround time. Journal of Clinical Microbiology, *50*(10), 3324–3328.
[16] Hansen, S. G., Skov, M. N., & Justesen, U. S. (2013). Two cases of Ruminococcus gnavus bacteremia associated with diverticulitis. Journal of Clinical Microbiology, *51*(4), 1334–1336.
[17] Kim, Y. J., Kang, H. Y., Han, Y., et al. (2017). A bloodstream infection by Ruminococcus gnavus in a patient with a gall bladder perforation. Anaerobe, *47*, 129–131.
[18] Gren, C., Spiegelhauer, M. R., Rotbain, E. C., et al. (2019). Ruminococcus gnavus bacteraemia in a patient with multiple haematological malignancies. Access Microbiology, *1*, Article e000048.
[19] Lefever, S., Van Den Bossche, D., Van Moerkercke, W., et al. (2019). Ruminococcus gnavus bacteremia, an uncommon presentation of a common member of the human gut microbiota: Case report and literature review. Acta Clinica Belgica, *74*(6), 435–438.
[20] Fernández Caso, B., Domingo García, D., Domingo, L. C., et al. (2017). Ruminococcus gnavus infection of a metal-on-metal hip arthroplasty resembling a pseudotumour in a 72-year-old woman with no intestinal symptoms. Enfermedades Infecciosas y Microbiología Clínica, *35*(8), 542–543.
[21] Roux, A. L., El Sayed, F., Duffiet, P., et al. (2015). Ruminococcus gnavus total hip arthroplasty infection in a 62-year-old man with ulcerative colitis. Journal of Clinical Microbiology, *53*(4), 1428–1430.
[22] Arnáez Solís, R., Martín Salas, C., & Acha Arrieta, M. V. (2017). Prosthetic joint infection by Ruminococcus gnavus in a patient without associated digestive disease. Medicina Clínica, *148*, e7–e8.
Medicinal, Psychological, and Health Research Journal (MPHRJ)
Volume 2, Issue 5
September and October 2026
Pages 400-408

Home

Editorial Board

Guide for Authors

Submit Manuscript

Contact Us