Infected Joint Replacement Research Articles

Triple antibiotics for the treatment of infected joint replacements: Case Report and Commentary

Combination antibiotics are frequently used in the treatment of infected joint arthroplasties to achieve synergistic activity against the infecting organisms. A case is presented in which triple antibiotic therapy was used in the treatment of an infected hip arthroplasty. The antibiotic combination proved to have an antagonistic effect despite documented sensitivities to the individual drugs. Serum antimicrobial assays are recommended in the treatment of all prosthetic joint infections.

The need for antibiotic coverage for dental treatment of patients with joint replacements

Patients with major joint prostheses, particularly total hip replacements, have an incidence of postoperative infection of about 1.3 percent. About 50 percent of the cases will occur within 3 months following surgery. Most cases are thought to be due to contamination of the wound at the time of surgery. About 0.3 percent of the THR cases develop infections due to hematogenous spread of bacteria from a distant site. In most cases there is active infection at the distant site and when the THR becomes infected the patient is acutely ill and the death rate is about 18 percent. In about 0.04 percent of the cases an active dental infection was thought to be the cause of the THR infection. No cases of THR infections have been documented as being caused by transient bacteremias secondary to dental manipulations. However, experimental studies have shown that transient bacteremias can infect total joint replacements in the rabbit. In addition, in about 20 to 40 percent of the patients with THR infections of hematogenous origin the site of origin could not be established; some of these cases could be of dental origin. The current practice of using prophylactic antibiotics before and following most dental procedures in patients with THR or other major joint replacements must be questioned from several viewpoints. The first, and most basic, relates to whether it is needed. Second, do the well-known complications associated with antibiotic prophylaxis outweigh the benefits of protecting against the extremely low risk of joint replacement infection secondary to transient bacteremias of dental origin? If future research establishes the need for prophylactic antibiotics to protect against transient bacteremias of dental origin from infecting joint replacements, then a standard approach to drug selection, dosage, and duration needs to be established on the basis of sound clinical studies and scientific information. It would appear that antibiotic prophylaxis prior to dental treatment is not indicated for patients with minor joint replacement or those who have screws or pins placed for bone fractures. When patients with major joint replacements develop dental infections, they must be treated with speed and effectiveness to prevent possible hematogenous spread to the replacement site. This treatment should include consultation with the patient's orthopedic surgeon.

Late anaerobic haematogenous infection of experimental total joint replacement. A study in the rabbit using Propionibacterium acnes.

Late anaerobic haematogenous infection of experimental total joint replacement. A study in the rabbit using Propionibacterium acnes.

Late Hematogenous Infection in Total Joint Replacement

Hematogenous infection of total joint replacements was experimentally produced in rabbits with cemented endoprostheses in both knees. One one side the bone cement contained gentamicin. Bacteremia was induced six to eight weeks postoperatively using a strain of Staphylococcus aureus. Twenty-five days after the induction of bacteremia approximately a third of the artificial joints were infected, whereas no bacteria were found in blood and viscera. Although the gentamicin cement still possessed anti-bacterial activity in vitro, it did not prevent hematogenous infection. Thus, gentamicin cement would not protect the joint against delayed hematogenous infection.

Hematogenous infection of total joint replacement. An experimental study in the rabbit.

(1981). Hematogenous Infection of Total Joint Replacement: An Experimental Study in the Rabbit. Acta Orthopaedica Scandinavica: Vol. 52, No. sup187, pp. 1-64.

Late hematogenous infection of total joint replacement.

Late deep wound infection secondary to hematogenous spread of bacteria from a distant focus is an infrequent but devastating complication of total joint replacement. Nine patients (ten implants) with documented late hematogenous infection are reported, all of whom demonstrated several characteristic features. The initial operation was free of clinical evidence of infection and a long asymptomatic interval ensued, followed by a definite febrile illness and acute joint pain. The source of the infection often was not recognized until late and prophylactic antibiotics were not given when it was identified. Seven of the ten implants had to be removed. The primary responsibility for the prevention of this devastating complication lies with the surgeon, who must inform each patient of the risk of late hematogenous seeding from infection elsewhere in the body. It is also important to pay special attention to patients who are at particularly high risk, such as those with rheumatoid arthritis or other systemic diseases. A knowledge of the bacterial flora of the various areas of the human body is essential in choosing the appropriate prophylactic antibiotic.

Hematogenous Infection in Total Joint Replacement

TOTAL joint replacement has been accepted as effective treatment for painful arthritis by the medical community. Indeed, between 1972 and 1976, an estimated 0.5 million joint prostheses were implanted in the United States.¹Infection of a prosthesis is one of the most serious complications of total joint replacement and is associated with serious morbidity and mortality.^2,3The pathogenesis of this infection, including portals of bacterial entry, is currently under debate, but evidence is accumulating to suggest that organisms are introduced by two routes: first, by local contamination at the time of surgery,⁴and later, by the hematogenous route.^5-7Prophylactic antibiotics and local wound care precautions can substantially reduce the incidence of early infections, but appear to have little effect on late sepsis.⁸We report here a case of<i>Staphylococcus aureus</i>hip sepsis occurring five years after total hip replacement, in association with an infected ulcer

Hematogenous infection in total joint replacement. Recommendations for prophylactic antibiotics

Hematogenous infection in total joint replacement. Recommendations for prophylactic antibiotics

Differential bone-scanning in the evaluation of a painful total joint replacement.

In an attempt to differentiate between loose and infected total joint replacements, seventy-nine patients were studied with both technetium-99 pyrophosphate and gallium-67 citrate bone scans. Seventy of these patients had positive technetium scans. Nineteen had positive gallium scans and all nineteen had positive cultures at the time of operation, while one patient had a false-negative gallium scan. Ten other patients who had negative technetium-99 scans and a painful total joint were followed without operative intervention. Of these, only two required operation after their technetium-99 scans became positive. Based on these studies, gallium-67 citrate scans combined with technetium-99 pyrophosphate scans are believed to be useful in differentiating between loose and infected prostheses. A negative technetium scan should weigh heavily against surgical exploration in an attempt to find the source of pain.

Effect of Gentamicin on Shear and Interface Strengths of Bone Cement

Antibiotic impregnated cement offers a potential method for salvage of infected total joint replacements. The addition of gentamicin in concentrations of .5, 1.0, and 2.0 per 40 significantly affects the shear strength of Palacos acrylic bone cement. The clinical significance of this strnegth drop is not clear. Large grained antibiotic additives have deleterious effect on shear strength. Measurements were made to determine the effect of gentamicin concentration on the bone-cement interface strength but no trend could be determined. The interface strength was much less than the strength of Palacos alone and suggested that bone strength is the limiting factor.

Hematogenous Infection in Total Joint Replacement

Hematogenous infections may appear at any time after joint replacement operations. As distinguished from delayed infections where general symptoms of infection are absent, hematogenous infections cause malaise, chills and fever, usually of the septic type. Roentgenograms of the joint at an early stage of hematogenous infection do not show any sign of infection as these take time to develop. Nor is the scintigram positive at an early stage. The diagnosis is beyond doubt only when the same strain of bacteria is cultured from the joint, a primary focus and blood.

Secondarily infected total joint replacements by hematogenous spread

Three fatal cases of infections that followed total joint replacement are repoarted, in each of which a hematogenous source of infection was identified. There also were five non-fatal cases presumable arising hematogenously which were reported in the literature. It is emphasized that concomitant disease, including active rheumatoid arthritis, may predispose to this complication.

Clostridial Infection in Total Hip Joint Replacement: A Report of Two Cases

Two cases of clostridial cellulitis are presented in patients who had Charnley total hip joint replacement for severe osteoarthritis. Early deep infection can be a major problem in this operation, and is usually due to Staphylococcus aureus.