What is a Periprosthetic Infection?
A very small percentage of patients who undergo joint replacement may develop an infection around the joint. This infection is called a periprosthetic infection.
How does a Periprosthetic Infection Occur?
Your immune system is usually able to protect the body from bacteria or other infectious organisms by attacking it through the lymph system or blood stream. However, your prosthesis, which is made of metal or plastic, does not have any blood vessels or lymphatic drainage, making it difficult for the immune system to gain access to and destroy these organisms. The bacteria can then multiply and cause the failure of the prosthesis.
Causes of Periprosthetic Infections
A periprosthetic infection may occur immediately after the surgery or even many years later. The most common way bacteria or any other infectious organism reach the joint is through:
- Breaks in the skin
- Dental procedures such as tooth extraction
- Other surgeries
Risk factors for Periprosthetic Infections
Factors that increase your risk of developing a periprosthetic infection are:
- Immunodeficiency disorders (e.g. HIV or lymphoma)
- Diabetes
- Peripheral vascular disease
- Obesity
- Immunosuppressive treatments
Symptoms of Periprosthetic Infections
You may have developed a periprosthetic infection if you notice the following signs and symptoms around your joint:
- Pain and stiffness
- Redness and warmth
- Fever and chills
- Weakness
Diagnosis of a Periprosthetic Infection
Your doctor will discuss your symptoms, ask about your medical history and perform a physical examination. Imagining studies such as X-rays and laboratory tests to identify the infection may also be ordered. Your doctor may also draw out fluid from your joint for a microscopic examination.
Treatment of Periprosthetic Infections
The various treatment options for periprosthetic infections include:
Nonsurgical Treatment of Periprosthetic Infection
If only the skin and the underlying soft tissue is infected, oral or intravenous antibiotics may be enough to treat the condition.
Surgical Treatment of Periprosthetic Infection
If the infection has penetrated the deeper tissues around the joint, surgical treatment is necessary. The various surgical treatment options include:
Debridement for Periprosthetic Infection
When the deep infection is diagnosed early, a surgical washout and debridement (removal of infected debris and dead tissue) may be all that is required to treat the condition. The implant is thoroughly cleaned during this procedure and any plastic liners or spacers may be replaced.
Staged-Surgery for Periprosthetic Infection
If the periprosthetic infection is diagnosed at a later stage, a 2-staged surgery may be performed. The first stage involves removal of the implant, washout of the joint, placement of an antibiotic spacer, which maintains the integrity of the joint, and the administration of intravenous antibiotics. The second stage, which occurs a few weeks later, is the placement of the new prosthesis after the removal of the antibiotic spacer and a surgical washout of the joint.
Single-Stage Surgery for Periprosthetic Infection
During this procedure, the infected implant is removed, the joint is washed out, and the new implant is placed within the joint. This relatively new method of treating a periprosthetic infection is slowly gaining popularity.
Prognosis Periprosthetic Infection Treatment
The prognosis for treatment of a periprosthetic infection is good if the infection is identified early and treated promptly. In case the infection has been present for some time, revision surgery and replacement of the prosthesis is usually necessary.