after total joint surgery can be a serious occurrence. In
our experience, and across the country, the risk of infection
after total joint surgery is approximately 1/2% or less. This
is equivalent to 1 case in 200 having an infection occur after
surgery. In most cases, these infections can be cured. They
may require the patient to be hospitalized longer, treated
with antibiotics for a longer period, or perhaps even to undergo
a second operative procedure.
of A Possible Infection
signs of a possible infection are:
temperature elevation (especially if prolonged)
swelling, redness, or tenderness
(pus) drainage from the incision
change in color or odor of drainage from the incision
a patient is hospitalized for a total joint replacement, the
prevention of infection begins in the operating room. Surgery
itself is performed in a sterile environment in the operating
room, with special air filters to help provide clean air that
is free of most bacteria. In addition, patients receive antibiotics
throughout their surgery via the IV line which is started
upon admission to the surgical area.
the hospitalization period, patients continue on their IV
antibiotics for 24-48 hours as a preventive measure. In addition,
careful examination of the incision, observation of any drainage,
and monitoring of the patient's temperature are all preventive
measure taken throughout hospitalization by the nurses and
physicians caring for the patient.
the time of discharge patients are given a list of discharge
instructions which contains the signs of infection and whom
to call if these signs become apparent. [Discharge
range post-operative prevention of infection is maintained
by total joint patients taking oral antibiotics prior to procedures
which could possibly introduce bacteria into the bloodstream.
[Antibiotics for Protection After
Total Joint Surgery] Once a patient has undergone total
joint surgery, he/she should always inform other physicians
that they have a joint replacement.
a patient does develop an infection after total joint replacement
surgery, it is either a superficial (localized) infection
or a deep infection. Treatment for the infection will be based
on several critieria. These criteria are:
type of organism causing the infection
organism's sensitivity to antibiotics
length of time of the infection
condition of the patient's bone
the diagnosis of the type of infection is made, treatment
is done in one of the following ways:
- Treatment for a superficial or localized infection consists
of antibiotics given either by mouth or by IV. Treatment
may be anywhere from 3 days to 1-2 weeks.
- For more serious localized infections an I & D
(incision and drainage), or "cleaning out" of
the surgical area may be performed. This is a limited surgical
procedure in which the wound is washed out and the patient
is treated with antibiotics IV. In this procedure all of
the original prosthetic components are retained.
- For a deep infection which has not advanced to the
bone, the recommended treatment is to perform a "direct
exchange." In this surgical procedure the total joint
components are removed, the surgical area is cleaned, and
new total joint components are inserted. These procedures
are performed at the same time, and the patient is treated
with IV antibiotics before, during, and after the surgery.
This treatment is performed for deep infections in which
the bone is involved. In the first surgery, all total joint
components are removed. The surgeon may then insert a temporary
prosthesis which is a "spacer" made of cement
and treated with antibiotics. This temporary prosthesis
is left in place for a period of time (usually 6-8 weeks),
during which the patient is also maintained on IV antibiotics.
A second surgical procedure is then done in which the surgeon
inserts new total joint components. This 2 stage treatment
of infection will necessitate separate hospital admission
for each surgical procedure.
- If a total joint replacement patient's infection cannot
be eliminated or if the condition of the bone is too severe
to allow for the exchange treatments discussed above, the
patient and surgeon may decide that the preferred option
is to remove all of the total joint components permanently.
In the case of a total knee patient, the procedure to be
performed is called a fusion, and in the case of a total
hip replacement the surgery would be a girdlestone procedure.
The goal in both procedures is to provide a stable, solid,
infection-free lower extremity which will allow the patient
to perform activities of daily living. However, neither
procedure allows normal joint function. Comfort and reasonable
activities are still possible. Surgical fusion of a knee
or girdlestone procedure of the hip is performed in less
than 10% of all infection cases after total joint surgery
or 1 in 2,000 cases.
stated above, the occurrence of an infection after total joint
surgery can be a serious event. Infection may occur immediately
after total joint surgery, after the patient goes home, or
even years later. For this reason if an infection develops
in any part of a total joint replacement patient's body, this
should be addressed. All total joint replacement patients
are advised to consult their physician if they experience
any signs of an infection. In addition, these patients are
advised to make any physicians they may see aware that they
have a total joint replacement. Careful follow-up of total
joint patients and appropriate communication between the patient
and their physicians are always the best measures in the prevention