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Knee News

Devastating Problem After Joint Replacement: Infection

As a natural consequence of rising numbers of total hip and total knee joint replacements has been the increase in number of postoperative infections. This complication can have devastating results. It is a complex and challenging problem to solve for a number of reasons.

First of all, general health and nutrition are very, very important in preventing infections or in the case of infections that do develop, in getting better. A healthy adult who is not overweight and does not have other problems has a better chance of recovery with less invasive treatment.

Second, older adults are living longer with more comorbidities. Comorbidities refer to other diseases and illnesses present at the time of the joint replacement surgery. For example, high blood pressure, heart disease, obesity, diabetes, cancer, thyroid problems, gout, and arthritis are just a few of the more common problems seniors have -- and most patients facing joint replacement have many health conditions referred to as multiple comorbidities.

Third, it's no secret that bacteria have become "superbugs" now. This means they are able to resist antibiotics previously used to kill them. They actually change their own structure and genetic code to shield themselves from the effects of antibiotics.

And finally, infections that develop later or that are not treated early can become chronic. These types of infections are even more difficult to stop. Even with treatment to clean out the joint, remove, and replace the implant, these bacteria linger and can resurface when the second surgery is done. Bacteria that enter the blood stream can also travel throughout the body, sometimes even causing death from a condition known as septicemia.

The fact is, infection after joint replacement is possible, affects up to two per cent of patients receiving their first implant, and costs four times the price of the replacement surgery. Surgeons are working hard to gather data and information that might help first with infection prevention and second with treatment.

Forty years of research has shown that cleaning the joint (a procedure called irrigation and debridement) isn't always enough. Current clinical guidelines based on evidence gathered over time recommend irrigation and debridement alone (preserving the original implant) only for certain patients.

These select individuals 1) are in good health with good nutrition and good immune system function, 2) do NOT have the type of bacteria that are antibiotic resistant, 3) DO have an acute infection (early on after surgery) that is diagnosed quickly, and 4) are able to follow their physician's advice about taking antibiotic therapy as directed.

Research is ongoing trying to sort out the best approach to the problem of infection after joint replacement. Best antibiotic to use, length of time to use it, and method of delivery remain under investigation. Some surgeons are trying direct infusion of antibiotics into the joint for six weeks. This treatment approach is called intraarticular infusion. Others are trying repeated irrigation and debridement procedures either alone or in combination with removal and replacement of the infected implant parts.

In summary, surgeons are reminded that irrigation and debridement to treat implant infection following either total hip or total knee replacements is not advised. Only those patients who meet the criteria just described should be selected for this more conservative care. There is plenty of evidence that irrigation and debridement alone will result in poor results and a poor prognosis with a high rate of implant failure.


Kwame Ennin, et al. Periprosthetic Joint Infection: Is Irrigation and Debridement Still an Acceptable Treatment Option? In Current Orthopaedic Practice. November/December 2012. Vol. 23. No. 6. Pp. 540-542.

12/19/2012

*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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