Introduction to Periprosthetic Joint Infection (PJI)
Infection after surgery is a dreaded complication for both doctors and patients. Periprosthetic Joint Infection (PJI), occurring after joint replacement surgeries like Total Knee Replacement (TKR) or Total Hip Replacement (THR), is one such challenge. While infections can be disheartening, advanced treatment protocols now make it possible to manage and cure them effectively. At Ashish Joint Replacement Care, we specialize in the comprehensive treatment of PJIs using a multidisciplinary approach.
What is Periprosthetic Joint Infection (PJI)?
Periprosthetic infection meaning refers to an infection that occurs around the artificial joint after total knee replacement (TKR) or total hip replacement (THR) surgery. These infections can be caused by bacteria attaching to the metal or plastic components of the implant. Such infections compromise the surgery’s success and require timely intervention.
Risk Factors for Periprosthetic Joint Infection
Not everyone undergoing joint replacement surgery is at the same risk. Several factors can increase the likelihood of developing a periprosthetic joint infection, including:
- Immune deficiencies such as HIV or lymphoma.
- Diabetes mellitus and other chronic conditions.
- Obesity and poor wound healing.
- Immunosuppressive treatments, including chemotherapy or corticosteroids.
- Peripheral vascular disease, which leads to poor circulation.
Understanding these risk factors of uncontrolled periprosthetic knee joint infection can help in taking preventive measures.
Periprosthetic Joint Infection Classification
Periprosthetic joint infections are classified based on their time of onset:
- Acute PJI: Occurs within four weeks after surgery.
- Subacute or Delayed PJI: Develops between 3 to 12 months post-surgery.
- Late PJI: Appears one to two years after surgery and is often caused by bacteria entering the bloodstream (hematogenous spread).
Total knee and hip replacements are among the most frequently performed elective surgeries, offering significant pain relief and improved mobility for most patients. These procedures enable individuals to lead fuller, more active lives.
However, like any surgery, joint replacement surgeries come with potential risks. Approximately 1 in 100 patients (1%) may experience an infection following their operation. These infections can affect either the wound site or the deeper areas around the artificial implants made of metal and plastic.
Infections may develop during the hospital stay, shortly after discharge, or even years later, emphasizing the importance of ongoing care and vigilance after joint replacement surgery.
We will discuss the following in this Article –
- Why joint replacements may become infected
- The signs and symptoms of infection
- Treatment for infections
- Ways to help prevent infections
This periprosthetic joint infection classification helps guide the treatment approach and prognosis.
Why Do Joint Replacements Become Infected?
Joint replacement infections occur when bacteria infiltrate the area around the artificial implant. While bacteria are naturally present in the gastrointestinal (GI) tract and on the skin, our immune system typically keeps them under control. When bacteria enter the bloodstream, the immune system swiftly identifies and eliminates the threat.
However, joint replacements, made of metal and plastic, present unique challenges for the immune system. Bacteria tend to adhere to metal surfaces, and since the metal implant lacks blood flow, the immune system cannot effectively detect or combat the bacteria. Once bacteria attach to the implant, they can multiply and lead to a joint infection.
Despite advances in antibiotics and preventive measures, treating infections in joint replacements often requires additional surgery to fully eradicate the infection. This highlights the importance of vigilance and prompt treatment in the rare cases where infection occurs.
Causes of Joint Replacement Infections
A total joint replacement can become infected at the time of surgery or at any point from weeks to years after the procedure. Bacteria can enter the body and lead to infection through the following common pathways:
- Breaks or cuts in the skin
- Major dental procedures (such as tooth extractions or root canals)
- Wounds from other surgical procedures
Some individuals face a higher risk of infection after joint replacement due to specific conditions or factors, including:
- Immune deficiencies (e.g., HIV or lymphoma)
- Diabetes mellitus
- Peripheral vascular disease (poor blood circulation in hands and feet)
- Immunosuppressive treatments (e.g., chemotherapy or corticosteroids)
- Obesity
Signs and Symptoms of Infection
Recognizing an infection early is critical for effective treatment. Common signs and symptoms include:
- Increased pain or stiffness in a previously well-functioning joint
- Swelling
- Warmth and redness around the surgical site
- Wound drainage (blood, pus, or other fluids)
- Fevers, chills, and night sweats
- Fatigue
Treatment for Joint Replacement Infections
Managing joint replacement infections typically involves a combination of approaches, including:
- Antibiotics to control bacterial growth
- Surgical intervention to remove the infection and, if necessary, replace the implant
Prompt medical attention and tailored treatment plans are essential to restore function and prevent further complications.
Diagnosis of Prosthetic Joint Infection
Timely and accurate diagnosis is essential for effective prosthetic joint infection treatment. Diagnostic methods include:
- Imaging tests: X-rays and bone scans to detect signs of infection.
- Laboratory tests: Tests such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to detect inflammation.
- Joint aspiration: Fluid from the affected joint is extracted and tested for bacterial presence.
Prosthetic Joint Infection Treatment Guidelines
Nonsurgical Treatment
In cases of superficial infection limited to soft tissues, antibiotics may suffice. Early diagnosis improves the chances of successful recovery without surgery.
Surgical Treatment
When the infection penetrates deeper into the joint, surgery becomes necessary. Depending on the severity, the following options are available:
- Debridement and Retention of the Implant
- The infected area is cleaned, and the implant is preserved.
- Intravenous antibiotics are prescribed for 6 weeks.
- Two-Stage Revision Surgery
- The infected implant is removed, and an antibiotic spacer is placed.
- After at least 6 weeks of antibiotics, a new implant is inserted.
- Single-Stage Revision Surgery
- Both removal of the infected implant and placement of a new one are done in a single procedure.
- Though less common, this method is gaining popularity due to promising outcomes.
These prosthetic joint infection treatment guidelines ensure that the infection is thoroughly addressed while maintaining joint function.
Antibiotic Spacer in a Hip Joint: A Critical Step in Infection Treatment
What is an Antibiotic Spacer?
An antibiotic spacer is a temporary device made from bone cement infused with antibiotics. It is placed in the joint to release antibiotics gradually into the surrounding tissues, helping eliminate infection.
Antibiotic Therapy for Staged Surgery
Patients undergoing staged surgery for joint infections typically require:
- Intravenous (IV) antibiotics administered through a tube in the arm or oral antibiotics, as determined by infectious disease specialists.
- A minimum of 6 weeks of antibiotic treatment, sometimes more, depending on the severity of the infection.
- Regular bloodwork to monitor the effectiveness of the antibiotic regimen.
Orthopedic surgeons collaborate closely with infectious disease specialists to decide:
- The appropriate type of antibiotics.
- The method of administration (IV or oral).
- The duration of antibiotic therapy
Candidacy for Revision Surgery
Once the infection is deemed cured—typically after at least 6 weeks of antibiotic treatment—patients may proceed to the next stage of treatment, known as revision surgery.
Stage 2: Revision Surgery Procedure
During the second-stage surgery, the orthopedic surgeon will:
- Remove the antibiotic spacer.
- Perform a thorough washout of the joint to ensure any residual infection is cleared.
- Implant a new total hip or knee replacement.
This comprehensive approach ensures the infection is resolved and the joint is restored, enabling improved mobility and quality of life.
Don’t let periprosthetic joint infections hold you back. Trust Dr. Ashish Singh, the best orthopedic surgeon in Patna and Bihar, for advanced and personalized treatment at AJRC
Revision Surgery and Infection Prevention: A Comprehensive Overview
X-Ray and Revision Surgery Components
This X-ray illustrates the knee components used in a stage 2 revision surgery. The implants have longer stems to support bone that may be compromised due to infection or removal of previous implants.
Single-Stage vs. Two-Stage Surgery
- Single-Stage Surgery:
- In this procedure, infected implants are removed, the joint is thoroughly cleaned (debrided), and new implants are placed—all in one surgery.
- Although not as commonly performed as two-stage surgery, single-stage surgery is gaining acceptance as an effective method for treating infected total joints.
- Ongoing research continues to evaluate the outcomes of this approach.
- Two-Stage Surgery:
- This method involves removing the implants in the first surgery, treating the infection, and later replacing the implants in a separate procedure.
- It remains the most widely used approach for managing joint infections.
Proven Ways to Prevent Infections During Surgery
Healthcare teams take numerous precautions during the original joint replacement surgery to minimize infection risks, including:
- Antibiotics
- Administered within 1 hour before surgery and continued at intervals for 24 hours post-surgery to combat bacterial exposure.
- Efficient Operating Practices
- Reducing operating time and limiting operating room traffic help lower exposure risks by minimizing the time the joint is exposed to contaminants.
- Sterile Techniques and Instrument Sterilization
- Meticulous sterilization of instruments and the surgical site ensures a sterile environment, reducing the risk of infection.
- Preoperative Nasal Screening
- Screening for bacterial colonization (e.g., Staphylococcus species) in the nasal passages weeks before surgery helps identify patients at higher risk.
- Positive cases may receive intranasal antibacterial ointments and tailored antibiotics to mitigate risks.
Pre-Surgery Measures to Reduce Infection Risks at Home
Patients can take specific steps before surgery to further reduce infection risks:
- Chlorhexidine Wash
- Using chlorhexidine-soaked cloths in the days leading up to surgery can help eliminate bacteria, particularly antibiotic-resistant strains.
- Skin Assessment
- Inform your doctor about any skin irritations, including cuts, scratches, rashes, or insect bites, on the limb to be operated on. Any active infection can lead to surgery cancellation.
- On surgery day, examine your skin for abnormalities and report them to your doctor.
- Avoid Shaving
- Refrain from shaving the surgical area at home; if required, it will be done in a controlled environment at the hospital.
H3 Long-Term Infection Prevention
After joint replacement surgery, your surgeon may recommend antibiotics before undergoing certain procedures, such as dental work. This helps protect the implants from bacteria that could enter the bloodstream during the procedure and cause infection.
By adhering to these preventative measures and staying vigilant, patients can significantly lower their risk of joint replacement infections and enjoy improved surgical outcomes.
Prevention of Periprosthetic Joint Infections
Prevention starts with choosing a reliable surgeon and a well-equipped facility. Here’s what AJRC emphasizes:
- Strict Sterile Techniques: We follow sterilization protocols to minimize contamination during surgery.
- NABH Accreditation: Ensures international standards of care.
- Laminar Airflow Operating Theatres: Specially designed to prevent infections during joint replacement surgeries.
- Preoperative Measures: Use of chlorhexidine washes and nasal screening for bacterial colonization.
Patients can also play a role by avoiding shaving the surgical area, maintaining good skin hygiene, and reporting any skin irritations before surgery.
Advanced Care for Periprosthetic Joint Infections at AJRC
At Ashish Joint Replacement Care (AJRC), we are dedicated to providing state-of-the-art treatment for periprosthetic joint infections. Our team, led by Dr. Ashish Singh, the best orthopedic surgeon in Patna and Bihar, specializes in managing complex cases with precision and expertise. Renowned for his exceptional skills in advanced orthopedic procedures, including robotic-assisted surgeries, Dr. Ashish Singh ensures that patients receive personalized care for optimal recovery.
With a multidisciplinary approach, we bring together expert orthopedic surgeons, physiotherapists, microbiologists, and pain management specialists to deliver holistic treatment. From imported implants to cutting-edge technologies and NABH-accredited facilities, AJRC is equipped to handle even the most challenging cases, ensuring the highest standards of care.
Conclusion
Periprosthetic joint infection is a challenging condition, but with prompt diagnosis, specialized care, and adherence to preventive measures, it can be managed effectively. If you or a loved one experiences periprosthetic infection symptoms, reach out to AJRC. Dr. Ashish Singh and his team provide comprehensive care tailored to your needs.
