Infection of the joint prosthesis

Joint replacement is a safe, cost-effective, and widely used procedure. Most prosthetic joint replacements are hip and knee but infection in the knee prosthesis is rare. However, this complication is associated with significant morbidity and economic cost. Diagnosis of infection is difficult because the symptoms, signs and studies are nonspecific. The criteria for diagnostic definition and optimal management are complicated by the heterogeneity of patients and the small number of patients in many of the published studies. However, early diagnosis facilitates timely intervention to save the infected knee, preserve its function, prevent morbidity and reduce costs.

Initially, prosthetic joint replacement infection occurs with wound inflammation, joint effusion, loss of function, and pain, with or without dehiscence of the suture or secretion. Later, pain or mechanical dysfunction appears. The general picture (fever, nausea and malaise) is non-sensitive and nonspecific. The onset of symptoms may be acute or insidious, with progressive pain or loss of function.

Infection rates vary according to the joint replaced, indication of arthroplasty, presence of comorbidities and prophylactic strategies. Obesity and diabetes are the diseases most associated with early infection. Renal transplantation or HIV infection has not been shown to increase infection of the prosthetic material in small cohort studies, but as arthroplasty is increasingly used, the risk is increasing. In Mayo Clinic publications, 25% of wound infections were associated with infection of the prosthetic material and the presence of any wound complication was significantly associated with a deep infection. In a prospective case-control study, persistent wound drainage for more than 5 days after surgery and wound hematoma were associated with infection of the prosthetic material (relative risk 1.3 and 11.8, respectively). These studies highlight the need for careful management of wound complications from arthroplasty.

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