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PROSTHETIC JOINT INFECTIONS

OVERVIEW
Prosthetic joint infections can typically occur either due to bacterial infections at the time of your joint replacement surgery or years thereafter spreading from an infection in your body. A microorganism may transpire in the body’s bloodstream and infect the prosthesis or spread from your skin at the time of the procedure. Usually, an immunocompromised person or a weak spot in your body’s defence mechanism due to a wound from surgery and the prosthetic implant is an open invitation for joint infections.

A prosthetic joint infection (PJI) is a type of infection that hones in on the prosthesis as well as surrounding tissue. Typical symptoms of PJI include pain near the wound, redness, inflammation around the joint, swelling and stiffness of the joint, discharge or draining wounds from the site of the cut, fever and lethargy.

 

THE SANDTON PROSTHETIC JOINT INFECTION UNIT
Started in 2021 by Prof Dick van der Jagt and Dr du Toit, The Sandton Prosthetic Joint Infection Unit manages severe conditions in a multidisciplinary setting. This dedicated multidisciplinary team specialises in treating patients with infections affecting the viability of a joint replacement prosthesis before the infection becomes limb- or life-threatening. A team of experts specialising in several fields of medicine are equipped to handle patients with severe illnesses and infections. By adopting a protocol-based approach as adhered to in international guidelines, the outcome for all patients can be improved upon drastically. The multidisciplinary team consist of orthopaedic surgeons, physicians, infectious disease specialists, microbiologists, histopathologists, orthotists, dieticians, physiotherapists, wound care specialists, radiologists, nuclear medicine physicians, psychologists, anaesthetists and plastic surgeons in order to ensure prosthetic joint infections are handled timeously and with great care.

A multidisciplinary team effort is essential when handling complex cases that generally necessitate longer hospital stays and higher expenses. A strong focus remains on a holistic approach to treatment and maintaining the mobility of the patient, and ensuring the longevity of the new joint prosthesis after the infection is resolved and the joint has been replaced.

PROSTHETIC JOINT INFECTIONS AND TREATMENT
The type of prosthetic infection and the severity determine the treatment the patient will receive.

There are several procedures to treat prosthetic joint infections, such as:

 
1DEBRIDEMENT, ANTIBIOTICS & IMPLANT RETENTION (DAIR)

This is a viable option if an infection is diagnosed and managed promptly. Surgical removal of necrotic tissue (debridement) involves reopening the wound and resecting dead tissue, and cleaning out the whole joint while the prosthetic is left in place. The plastic or easily removable components are replaced with new clean components. Antibiotics in the wound, as well as intravenously, are given in order to eradicate the infection.

2STAGED SURGICAL REVISION

Surgical revision is a procedure that entails replacing the entire prosthetic joint. This is usually done in two separate sittings or surgeries. The first surgery involves placing antibiotic cement spacers that substitute the prosthetic in the joint. Systemic antibiotics are given for an extended period until the infection is cured. Then, once the infection is gone, a second surgery is done by Dr du Toit, where he rebuilds the joint by inserting and fixating a new prosthetic device.

3AMPUTATION

Amputation occurs in severe cases where the infected joint cannot be cured. The infection can also turn fatal by spreading to the rest of the body. As a result, the infected joint, including the limb, must be removed.

4REHABILITATION AFTER SURGERY

It can take up to a year to recover from revision arthroplasty. However, many patients return to work within three to six months after the procedure.

 

    JOINT REPLACEMENT SURGERY

    PROSTHETIC JOINT INFECTIONS

    ORTHOPAEDIC ONCOLOGY

    GENERAL PROCEDURES

 

FAQ

  1. HOW DO YOU PREVENT PROSTHETIC JOINT INFECTIONS?
    There are a few ways to prevent the development of prosthetic joint infections of which include:
    • Controlling your blood sugar
    • Controlling your weight
    • Stop smoking
  2. HOW DO YOU DIAGNOSE PROSTHETIC JOINT INFECTIONS?
    First, a physical exam is done beforehand to evaluate your symptoms. In addition, Dr du Toit may find it necessary to conduct the following tests:
    • A blood test is done to assess high levels of white blood cells or markers like a CRP or ESR, which are indicative of an infection or inflammation.
    • Sterile Joint Aspiration extracts synovial fluid (joint lubricate) that is assessed under the microscope and cultured.
    • A bone scan is a source of imaging done to find areas of suspected infection or implant loosening in a specific area.
    • CT and MRI scans develop detailed images of bone, tissue and blood vessels to assess the extent of damage done.
    • Tissue Biopsy extracts a sample of tissue to check for microorganisms responsible for the infection.
  3. HOW DOES A PROSTHETIC JOINT BECOME INFECTED?
    Bacteria from your skin or from elsewhere in your body/bloodstream, during or long after surgery, bypasses your immune system and adheres onto the artificial joint implants leading to a prosthetic joint infection.
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