Houston Methodist. Leading Medicine



My grandpa has asked me to write you a question. Gramma had a hip replacement last month. Now it has gotten infected. The doctor wants to put something called a "pick line" into her so she can have antibiotics direct to the blood. Why can't she just take the pills like always? As Grandpa puts it, "Why do they insist on new-fangled stuff when the old way works perfectly fine?"


Total hip (and total knee) replacements are becoming commonplace among American seniors. Complications are always a possibility after any surgery. Infection is one of the most common problems. Current studies suggest that up to two per cent (two out of every 100 patients) develop a joint infection after a total hip replacement. The ideal treatment is with antibiotics early on to nip the problem in the bud, so-to-speak. Most surgeons prefer to put their patients on intravenous antibiotics for six weeks. Since it is difficult to insert the line into the patient everyday to accomplish this, they use something called a peripherally-inserted central catheter or PICC line. Peripheral lines mean the needle with an opening/plug is inserted up by the collarbone or chest area. A tube called a catheter inserts into the PICC to administer the drug daily. Then the tube is taken off leaving the base unit in place (now plugged up) and ready for the next dose. In many places, the patient can actually self-administer the daily antibiotic. Since this is a six week course of treatment, home care with a PICC line is very helpful. There has been at least one study done showing that intravenous antibiotics can be given for two weeks and then the patients are switched to an oral (pill by mouth) antibiotic. Early studies show this method is effective and the infection does not return. More studies will be needed before this becomes a standard treatment method. Tha major concern here is to clear up the infection once and for all. It would be unfortunate to replace the infected joint only to have the same thing happen a second time. Intravenous antibiotics go directly into the blood and are more powerful and effective than the oral (by mouth) pill form. At least that is the current thinking for acute (early on) infections. H. John Cooper, MD, and Craig J. Della Valle. Management of Infection After Total Hip Arthroplasty. In Current Orthopaedic Practice. November/December 2012. Vol. 23. No. 6. Pp. 543-548.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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