Image Credit: Texas Infectious Disease Institute
“Take care of your body, it’s the only place you have to live.”
– Jim Rohn
Article Authors: Gordon Slater| Tandose Sambo
Total joint replacement is a surgical procedure that is utilised as a treatment option for advanced stages of orthopaedic procedures such as arthritis. Ideally, after a joint replacement, patients expect to have a full recovery, and live a happy and normal life. Every now and then, however, there are instances where patient recovery after a surgical procedure, may be wrought with additional complications, such as a downstream infection.
Periprosthetic Joint Infection (PJI) is a condition that can affect patients during the recovery phase of their joint replacement, if the appropriate care is not taken to keep the joint area in a state that is not conducive to bacterial growth.
Once the condition develops, one of the greatest orthopaedic challenges that may arise, is the best course of treatment of the infected joint. Since both surgical and non-surgical management methods to treat PJI exist, many decisions have to be made in order to determine the best path forward.
What are the impacts of PJI?
Joint arthroplasties are one of the most common surgical procedures being conducted globally, and the post surgical complications are increasing. PJI is one of the categories that induces substantial financial burdens on both patients and the healthcare system. By 2020, total costs of hospital revisions were estimated to exceed $1.62 billion.
How does PJI form?
PJI is formed by the adherence of bacteria to the implanted prosthetic joint. The bacteria may be present in the biomaterial and surrounding joint fluid. Biofilms (complex structures of microorganisms) can also house bacteria close to the prosthetic joint. Staphylococci is one bacteria that can exist inside the joint framework. Via various mutations, the organism is one that has been found to have a resistance to some types of antibiotics and even to the immune system.
Other PJI infections can be caused by Gram-positive cocci (Staphylococcus aureus and coagulase-negative Staphylococcus). Other bacteria and fungi can also cause PJI.
During a physical examination, as well as via a series of medical tests, the exact strains of the microorganism that causes the PJI can be identified. The treatment plan can then be designed according to the lab results. Patients will often experience acute joint pain, inflammation of the joint, and joint instability.
Treatment for Periprosthetic Joint Infection
Treatment for PJI can range from acute treatment to more advanced treatments. Acute treatment for PJI can involve the utilisation of antibiotics. Additionally, practice of good hygiene can reverse the effects of PJI. Via irrigation and debridement and exchange of modular parts of the prosthesis will normally clear up any acute conditions that may persist. In an acute infection, the bacterial layer on the prosthetic is not deep enough to cause any adverse accumulation that can be resistant to treatment.
On a more advanced level, staged removal and exchange of parts of the prosthetic can be conducted by an orthopaedic surgeon. These methods require surgical intervention.
Conclusion
As treatment for PJI becomes more standardised, the best way to ensure that PJI is prevented is to ensure that the highest hygiene standards are upheld during pre and post surgical care.
Reference Article:
National Library of Medicine : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601222/
