Infection following joint replacement surgery 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. In this blog, we will examine the causes, symptoms, diagnosis, and treatment approaches for infections after joint replacement surgery.

Periprosthetic infection after hip and knee replacement

Causes of infection of a prosthesis

A prosthesis can become infected through various mechanisms. The main causes of infection are:

1. Intraoperative contamination: Bacteria enter the body during surgery.
2. Hematogenous spread: Bacteria from other infected body regions reach the prosthesis via the bloodstream.
3. Per continuitatem: Spread of bacteria from adjacent 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 prosthetic 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 that often increases slowly, as well as a gradual loosening of the prosthesis.
• Acute hematogenous infection: Sudden pain, swelling and systemic signs such as fever.

Diagnostics

The diagnosis of a prosthetic infection involves several steps:

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

Therapeutic approaches

The treatment of an infected prosthesis depends on the timing of the infection and the patient's state of health:

1. Early infection: In cases of early infection, the prosthesis can often be preserved. This requires thorough cleaning of the joint (debridement) and intensive antibiotic therapy.
2. Late infection: In most cases, a two-stage replacement of the prosthesis is necessary. The infected prosthesis is removed and, after a period of intensive antibiotic therapy, replaced with a new one.
3. Single-stage replacement: In some cases, the prosthesis can be replaced immediately in a single operation. This allows for faster mobilization of the patient.

Preventive measures

The prevention of prosthetic infections begins even before the operation:

• 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 follow-up care

An 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 reinfection: Patients with a history of prosthetic infections have a higher risk of future infections.

Follow-up care includes regular check-ups and close collaboration with various medical disciplines to detect and treat any reinfection early.

Conclusion

An infection following prosthetic implantation is a serious complication requiring prompt and comprehensive medical intervention. Preventive measures, early diagnosis, and appropriate treatment approaches can minimize the risk and improve patients' quality of life. Affected individuals should seek treatment at specialized centers and from endoprosthetics specialists to ensure the best possible care.