Infection After Total Joint Surgery
Infection 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.
Signs of a Possible Infection
The signs of a possible infection are:
- a temperature elevation (especially if prolonged)
- localized swelling, redness, or tenderness
- purulent (pus) drainage from the incision
- any change in color or odor of drainage from the incision
Prevention of Infection
When 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.
During 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.
At 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.
Long 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. Once a patient has undergone total joint surgery, he/she should always inform other physicians that they have a joint replacement.
Treatment of Infection
If 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 criteria. These criteria are:
- the type of organism causing the infection
- the organism’s sensitivity to antibiotics
- the length of time of the infection
- the condition of the patient’s bone
Once the diagnosis of the type of infection is made, treatment is done in one of the following ways (click a heading below to learn more):
Incision and Drainage
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.
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 of infection.