Infection following prosthetic implantation is one of the most serious complications that can occur. It can significantly impair the function of the implanted joint and often requires complex and lengthy treatment measures. In this blog we will shed light on the causes, symptoms, diagnostics and therapeutic approaches of infections after prosthesis implantation.

Periprosthetic infection after THA and TKA

Causes of infection of a prosthesis

Infection of a prosthesis can occur through various mechanisms. The infection mainly occurs through:

1. Intraoperative contamination: Bacteria enter the body during surgery.
2. Hematogenous spread: Bacteria from other infected areas of the body reach the prosthesis via the bloodstream.
3. Per continuitatem: Spread of bacteria from neighboring infected tissues.

The most common pathogens are highly virulent bacteria such as Staphylococcus aureus and gram-negative bacteria, but low-virulence germs such as Staphylococcus epidermidis can also cause infections.

Symptoms of a denture infection

Symptoms can vary depending on the type of infection. The most common signs include:

• Early infection (within the first 4 weeks after surgery): pain, redness, swelling and increased temperature in the area of ​​the implanted joint.
• Late infection (more than 4 weeks after surgery): Chronic pain, which often increases slowly, and gradual loosening of the prosthesis.
• Acute hematogenous infection: Sudden pain, swelling and systemic signs such as fever.

Diagnosis

Diagnosing a denture infection involves several steps:

1. Clinical examination: assessment of the patient's symptoms and history.
2. Imaging: X-rays and, if necessary, MRI or CT to detect changes in the joint.
3. Laboratory tests: Determination of inflammatory parameters in the blood (CRP, ESR, leukocyte count).
4. Joint puncture: collection and analysis of synovial fluid for microbiological examination.

therapeutic approaches

Treatment of an infected prosthesis depends on the time of infection and the patient's health status:

1. Early infection: In the event of an early infection, the prosthesis can often be retained. This requires thorough cleaning of the joint (debridement) and intensive antibiotic therapy.
2. Late infection: A two-stage change of the prosthesis is usually necessary. This involves removing the infected prosthesis and replacing it with a new prosthesis after a phase of intensive antibiotic therapy.
3. One-time replacement: In some cases, the prosthesis can be replaced immediately in one operation. This enables faster mobilization of the patient.

Prevention measures

Prevention of denture infections begins before surgery:

• Strict hygiene measures in the operating room: reduction of intraoperative contamination risks.
• Optimizing patient health: treating existing infections and improving immune status before surgery.
• Antibiotic prophylaxis: Administration of antibiotics before, during and after surgery to minimize the risk of infection.

Long-term effects and aftercare

Infection of the prosthesis can have long-term consequences, including:

• Impaired joint function: Repeated surgeries can affect the stability and function of the joint.
• Chronic pain: Persistent discomfort despite successful treatment of the infection.
• Increased risk of re-infections: Patients with a history of denture infections are at higher risk of future infections.

Follow-up care includes regular checks and close collaboration with various medical disciplines in order to detect and treat a new infection at an early stage.

Conclusion

Infection after prosthesis implantation is a serious complication that requires rapid and comprehensive medical intervention. Through preventive measures, early diagnosis and appropriate therapeutic approaches, the risk can be minimized and the quality of life of patients can be improved. Those affected should seek treatment in specialized centers and with endoprosthetic specialists to ensure the best possible care.