Joint replacement, such as a total knee and total hip replacement, is one of the most frequently carried out elective operations. In most cases, joint replacement surgery relieves pain and helps patients live full, active lives. However, a small number of patients undergoing joint replacement—about 1%—may develop a postoperative infection. Treating infection after joint replacement requires urgency and care to minimize the risk of long-term complications.
Joint replacement infections can occur in the surgical wound or deep around the artificial implants. Such an infection can also develop during the hospital stay or after returning home, as well as immediately postoperatively or up to years after a surgery 1. There are several ways of treating infections following a joint replacement.
First, when a joint infection is suspected, early diagnosis and proper treatment increase the probability that a patient is able to keep their implants. A patient’s doctor will discuss their medical history and carry out a detailed physical exam, after which a number of tests might be carried out, including imaging tests and specific blood tests in the lab.
In certain cases, only the skin and soft tissues around the joint are infected. Since the infection has not spread deep into the artificial joint itself, this is called a “superficial infection.” If the infection is detected early enough, a patient’s doctor may swiftly prescribe oral or even intravenous antibiotics. This type of treatment has a good success rate for early superficial infections.
Infections that extend beyond the superficial tissues and gain deep access to the artificial joint almost always require specialized surgical treatment 2.
Debridement. Deep infections that are identified early on enough, within days of onset, as well as infections that occur within weeks of the original surgery, may sometimes simply be cured through a surgical washout of the joint.
Staged surgery. In general, however, the longer the infection has been present, the harder it is to cure it without removing the actual implant. Late infections, such as those that occur months to years following the joint replacement surgery, as well as long-term persistent infections, tend to require a staged surgery. In the first stage, the surgeon removes the implant, performs a washout of the joint and soft tissues, places an antibiotic spacer, and delivers intravenous antibiotics. In the second stage, the surgeon removes the antibiotic spacer, performs a washout of the joint again, and implants new total knee or hip components.
Single-stage surgery. Some cases may require a single-stage surgery. In this case, the implants are removed, a washout of the joint is performed, and new implants are placed all in one go. Single-stage surgery is not as frequently performed as two-stage surgery, but it is gaining traction as a well-established method for the treatment of infected joints. Physicians are continuing to study the outcomes of single-stage surgery in order to best inform their clinical choices.
At the time of original joint replacement surgery, certain measures can be taken in order to minimize the risk of infection. Some steps have been demonstrated to lower the risk of infection, while some are thought to help without having yet been scientifically proven. The most important known measures to lower the risk of infection following total joint replacement include taking antibiotics before and after surgery, reducing the operating time, and using sterile techniques and instruments 3.
1. Joint Replacement Infection – OrthoInfo – AAOS. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/joint-replacement-infection/. (Accessed: 9th May 2023)
2. Joint Replacement Infection | Hip & Knee Replacement | UCI Health | Orange County, CA. Available at: https://www.ucihealth.org/medical-services/orthopaedics/hip-knee-surgery-services/joint-replacement-infection. (Accessed: 10th May 2023)
3. Infection After Total Joint Replacement Surgery. Available at: https://www.verywellhealth.com/infection-of-a-joint-replacement-2548642. (Accessed: 10th May 2023)