Joint Prostheses Infection: Why Does It Occur?

Infection of joint prostheses is a comparatively common complication after arthroplasty. Implanting prostheses is now a quite common operation that helps within the treatment of many pathologies related to the bone apparatus.

Most cases involve hip or knee replacements. Although these are procedures with superb results, nonetheless, like every other surgical technique, they will be related to complications. Why does this infection occur? What are its symptoms? We will answer these questions below.

What is a prosthetic joint infection?

Prosthetic joint infection can be often called “periprosthetic infection”. This is a complication that threatens each the joint alternative area and the adjoining tissues.

Arthroplasty is the medical name for this procedure. According to information from Clinica Universidad de Navarra, around 30,000 such interventions are carried out annually in Spain. It is a secure procedure that usually leads to a major improvement within the patient’s quality of life.

The joints will almost certainly get replaced with a prosthesis it’s hip and knee.

Nevertheless, as stated within the publication in Clinical Microbiology Reviews, a minority of patients will experience device failure and would require additional surgery sooner or later of their lives. It is estimated that 2-4% of arthroplasty cases end in infection.

The big concern is that it will possibly cause other serious complications in addition to high costs to the healthcare system. It is in itself normally attributable to the patient’s own bacteriawhich form a gelatinous matrix on the prosthesis.

This happens when these microorganisms attach to the surface of the prosthesis. There they multiply and provides rise to this matrix, which is known as a biofilm. This is a mechanism that protects them from the consequences of antibiotics, making them more immune to treatment.

Why can a joint prosthesis turn out to be infected?

Infection of joint prostheses will be attributable to several types of bacteria. As now we have indicated, they adhere to the prosthesis and form the so-called biofilm. To do that, they organize themselves into layers, one on top of the opposite. This explains why those in deeper layers are more immune to antibiotics.

Same prosthesis also changes the function of some cells of the immune system, like phagocytes. All these aspects favor the progression of the infection and make it difficult to treat.

Usually the bacteria involved are staphylococci. Microorganisms are essentially the most common on this group Staphylococcus aureus AND Staphylococcus epidermidis. Other agents involved include:

• Escherichia coli
• Pseudomonas aeruginosa
• Enterococcus spp

It can be a multibacterial infection. This means it will possibly be attributable to multiple bacteria. Fungal infections are less common.

Types of infection

Infection of joint prostheses it is normally classified by evolutionary time. Some authors distinguish between acute and chronic infection. However, as explained in Prioam’s guideit will possibly even be classified as follows

• Early postoperative infection (PPI)
• Late Chronic Infection (LCI)
• Acute blood-borne infection (AHI)

Those who distinguish only acute and chronic infection include acute blood-borne infection in the primary group.

Early postoperative infection or acute infection

An early postoperative infection is one which occurs in the primary month after wearing the prosthesis. Some imagine it remains to be considered an acute infection up to a few months after surgery.

There are numerous criteria that help discover the sort of prosthetic joint infection. Postoperative wound dehiscence and suppuration normally occur. In addition, when the fluid is faraway from the joint and tested within the laboratory, the presence of bacteria is usually detected.

In these cases, early diagnosis and treatment are essential. In this fashion, you’ll be able to avoid having to switch your prosthesis because of infection.

Acute blood-borne infection

Acute blood-borne infection occurs when the main target of infection is elsewhere within the body. In other words, the bacteria can come from one other process, reminiscent of pneumonia, urinary tract infection, endocarditis, etc. What happens is that they’re mobilized with the blood and eventually colonize the prosthesis.

Infection of the joint prosthesis of the chronic type

Chronic infection is normally considered when three months have passed because the prosthesis was placed. Because the treatment is more complicated than acute bacterial biofilm mature and can’t be removed.

This condition develops progressively and insidiously. The pain persists for months, although there are not any obvious signs of infection or fever. In some cases, abscesses and fistulas may occur. In these cases, it is normally needed to switch the prosthesis.

accompanying symptoms

The symptoms of a joint prosthesis infection vary depending on whether or not they are acute or chronic. It ought to be noted that about half of the cases are chronic. This is why, certainly one of the dominant symptoms is inflammatory pain.

The problem is that arthroplasty may cause pain without necessarily causing infection. Therefore, it is usually difficult to make an accurate diagnosis. In addition to pain, there could also be a scarcity of functionality within the joint.

In the case of an acute infection, patients normally show fever. The surgical wound doesn’t heal properly, purulent substance may ooze through the wound. The area is normally swollen, warm and red.

How is joint endoprosthesis infection diagnosed?

Diagnosis of the sort of infection ought to be made early. This prevents the infection from becoming chronic and the necessity to repeat the operation. To do that, it can be crucial to observe the patient properly and concentrate to any warning signs.

However, there are numerous complementary tests that can assist make a diagnosis. One of them is positron emission tomography. This is a glucose tracer technique. This molecule is captured by the bacteria that cause the infection.

In this fashion, with the assistance of a scan, it is feasible to evaluate the areas where bacteria are positioned. Other useful tests include synovial fluid evaluation and blood tests. Ultrasounds and x-rays can also be useful.

Treatments available

Infection of joint endoprostheses requires multidisciplinary treatment. In every kind, drug and surgery is normally combined. Drug treatment consists of pain relief and the administration of certain antibiotics to treat the infection.

Surgery will be used to scrub and purify tissues. In cases where infection is chronic, alternative of the prosthesis will likely be needed. This will be done as a one-step or two-step procedure.

This implies that a recent prosthesis will be placed in the identical operation. The two-step option is to remove the prosthesis, cleansing the realm and applying a spacer containing antibiotics. Then, in a subsequent operation, a recent prosthesis is placed.

To start treatment with antibiotics, it is strongly recommended to first discover the causative germ and its sensitivity to those drugs. The duration of treatment will be long. In some cases, reminiscent of knee replacements, six months of treatment could also be advisable.

Remember: Infection of prosthetic joints will be serious

Although it shouldn’t be a quite common complication, surgeons are very concerned about denture infection. This is because in some cases it requires further surgery and alternative of the prosthesis.

It is very important for patients to concentrate on the signs and symptoms in order that they’ll detect infection early. In addition, doctors should make a diagnosis as soon as possible, as this reduces the likelihood of needing re-operation.

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