Patient Guide: Infected Total Hip and Knee Replacement 

‍ Symptoms  and Causes 

Infections in total hip or knee replacements can lead to a range of symptoms, including:

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Increased pain and stiffness in the joint: This may be worse during movement or may persist even at rest.

Swelling and redness: The joint area may appear swollen and can show signs of redness, indicating inflammation.

Warmth in the area of the joint: The skin over the joint may feel warm or hot to the touch.

Fever and chills: These are general symptoms of an infection in your body.

Fatigue or feeling unwell: This can accompany the fever and chills as your body is fighting off the infection.

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These infections can occur when bacteria, usually from the skin or intestinal tract, get into the bloodstream during or after surgery and settle in the joint. Factors like diabetes, obesity, rheumatoid arthritis, or having a weakened immune system can increase this risk.

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 Presenting Signs, X-rays, and Exam

On a physical exam, your doctor may find that the joint is warm and swollen, and that moving the joint is painful. Blood tests can show signs of infection, such as a high white blood cell count or elevated levels of inflammatory markers. However, these tests are not specific and can be raised in other conditions too.

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X-rays of the joint can show changes that suggest an infection, such as loosening or shifting of the prosthesis. Sometimes, however, the X-ray may look normal even if an infection is present. More detailed imaging studies like a CT scan or MRI may be needed.

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An important part of the diagnosis is taking a sample of fluid from the joint (aspiration) and sending it to the lab to identify the bacteria and test its sensitivity to different antibiotics.

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Procedures

Once an infection is confirmed, treatment involves both surgery and antibiotics. There are two main types of surgery:

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1. Debridement: In this procedure, the surgeon opens up the joint and cleans out the infected tissue. If the artificial joint is not loosened, it may be left in place. Otherwise, it may need to be removed and replaced. This is often done if the infection is caught early and is caused by bacteria that are not highly resistant to antibiotics.

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2. Staged surgery: This is done for more complex or long-standing infections. The infected joint and surrounding tissue are removed, and a temporary spacer is placed in the joint. This spacer is often made of cement and is loaded with antibiotics to help fight the infection. After the infection has cleared (usually in 6 weeks to 3 months), a second surgery is done to remove the spacer and put in a new artificial joint.

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 The Role of Antibiotics 

Antibiotics play a crucial role in treating these infections. They are usually started as soon as an infection is suspected, even before surgery. Initially, broad-spectrum antibiotics are used, which work against a wide range of bacteria. Once the lab identifies the bacteria from the joint fluid, the antibiotics can be adjusted to target those specific bacteria.

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Typically, IV antibiotics are given for six weeks. Sometimes, oral antibiotics may be given after this, especially in patients who have a high risk of recurrence.

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Dr. Vilas Saldanha’s Approach

Dr. Saldanha employs the latest techniques in treating joint infections, including the use of local antibiotic delivery devices. These devices are implanted into the joint during surgery and deliver a high concentration of antibiotics directly to the infection site. This method can be more effective than IV antibiotics alone and can help clear the infection more quickly. By incorporating such advanced techniques, Dr. Saldanha ensures a comprehensive approach to managing joint infections.

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Roadmap

Preoperative:‍

Diagnosis is made based on symptoms, signs, blood tests, joint fluid analysis, and imaging studies. The plan for surgery is discussed, and antibiotics are started.

Postoperative 1 month:

This is the acute recovery period. You'll continue on IV antibiotics and have regular wound care. The surgical wound should start to heal, and any staples or sutures may be removed. You'll start gentle physiotherapy exercises to maintain joint mobility. 

Postoperative 3 months:‍

Your wound should be fully healed by now. Your doctor will assess your healing progress, joint function, and any signs of ongoing infection. Imaging studies may be done to check the position and stability of the joint. If you had a staged surgery, you'll likely have your second surgery around this time.

Postoperative 6 months:‍

You'll have another check-up to assess recovery and function of the new joint. If your recovery is progressing well, you'll continue with physiotherapy exercises to strengthen the muscles and improve the range of movement in the joint.

Postoperative 1 year:‍

You'll have a routine follow-up to monitor joint function and health. X-rays may be taken to check for any signs of loosening or wear of the joint. If all is well, you'll continue with regular activities and exercises.

Postoperative 5 years:‍

This is a long-term follow-up, assessing the longevity and function of the joint. Further follow-ups will be scheduled based on your individual condition and the type of joint implanted.

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1. Berbari, E., Mabry, T., Tsaras, G., et al. (2010). Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. *J Bone Joint Surg Am*, 92(11), 2102-2109.

2. Osmon, D.R., Berbari, E.F., Berendt, A.R., et al. (2013). Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. *Clin Infect Dis*, 56(1), e1-e25.

3. Tande, A.J., & Patel, R. (2014). Prosthetic joint infection. *Clin Microbiol Rev*, 27(2), 302-345.

4. Zimmerli, W., Trampuz, A., & Ochsner, P.E. (2004). Prosthetic-joint infections. *N Engl J Med*, 351(16), 1645-1654.

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Always remember, your healthcare provider is your primary source of information. This guide is to be used as a supplement and should not replace professional medical advice.

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