Prosthetic Joint Infection: Symptoms, Diagnosis, Treatment, Prevention

What is joint replacement surgery?

Joint replacement surgery is a proven and safe procedure that can provide better quality of life to patients by alleviating symptoms, improving mobility, and restoring of joint function.

The most common reason for joint replacement surgery is osteoarthritis, a degenerative condition that affects the joint’s cartilage, causing pain, stiffness, and reduced range of motion.

Additionally, joint replacement surgery may be necessary for conditions such as rheumatoid arthritis, joint injuries or trauma, and avascular necrosis (a condition characterised by diminished blood flow to the bone).

What are prosthetic joints?

Prosthetic joints are artificial devices that replace a damaged or diseased joint. There are two main types of prosthetic joints:

Total joint replacement: Replaces the entire joint.
Partial joint replacement: Replaces only the damaged or diseased parts of the joint.

Prosthetic joints - typically made from metal, plastic, or ceramic materials - are designed to mimic the functionality of a natural joint. These artificial joints are attached to the bones using cement or other fixation devices and are typically designed to last for an extended period, often spanning many years.

The lifespan of a prosthetic joint can vary depending on factors such as the patient's age, activity level, and overall health.

What is prosthetic joint infection?

A prosthetic joint infection is an infection that occurs in a joint replacement, such as a hip or knee replacement. This type of infection can occur within the first few months after surgery or even years late.

What are the causes of prosthetic joint infection?

A small percentage of people with replacement joints are at risk of developing an infection. Prosthetic joint infections can be caused by a variety of factors, including:

Bacterial contamination during surgery caused by improper sterilisation of equipment or poor surgical technique.
Pre-existing infection such as a urinary tract infection can spread to the prosthetic joint through the bloodstream.
Poor wound healing can increase susceptibility to bacterial infection.
Immunocompromised patients with weakened immune systems, such as those with diabetes or human immunodeficiency virus (HIV), are at a higher risk of developing prosthetic joint infection.
An allergic or hypersensitivity reaction to the implant material may lead to inflammation and infection.
Poor oral hygiene can lead to the growth of bacteria in the mouth, which can travel to the prosthetic joint through the bloodstream.
Prosthetic loosening can create space for bacteria to grow and cause an infection.

What are the symptoms of prosthetic joint infection?

It is important to contact your doctor right away if you experience any of the following symptoms after a joint replacement surgery:

Warmth, tenderness, and redness at the incision site
Wound drainage
Joint effusion
Fever
Persistent joint pain
Fatigue

How is prosthetic joint infection diagnosed?

The diagnosis of prosthetic joint infections can pose challenges because the symptoms may be non-specific and resemble other conditions. However, when patients with a joint prosthesis exhibit relevant signs and symptoms of infection, prosthetic joint infection should be considered as a potential cause.

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

Blood tests can help determine if there is an infection present in the body. Your doctor may order tests such as a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels.
Imaging tests such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans can help detect any changes in the bone or soft tissue around the joint.
Aspiration of fluid from the joint is cultured to determine if there is any bacterial growth. A positive culture indicates the presence of an infection.
Biopsy may be necessary to confirm the diagnosis of prosthetic joint infection in some cases. Your doctor may take a small sample of tissue from around the joint and send it to the lab for testing.

What are the treatment options for prosthetic joint infection?

Prosthetic joint infection can be hard to treat due to the development of biofilm within the joint. When bacteria adhere to the solid surface of an artificial joint, a biofilm forms. The biofilm can function as a shield for some bacteria, making it difficult to detect and destroy them with the body's natural defences or antibiotics.

The treatment of prosthetic joint infection typically involves a combination of surgical intervention and antibiotic therapy.

Surgical intervention

The surgical treatment of prosthetic joint infection may involve one or more of the following procedures:

Debridement and retention of prosthesis: This involves the removal of infected tissues around the joint and retention of the original joint implant.
Resection arthroplasty with reimplantation: This involves removing the infected implant and replacement with a new implant.
Fusion or amputation: In some cases where the infection is severe and cannot be treated with other methods, joint fusion or amputation may be necessary.

Antibiotic therapy

The type of antibiotic and duration of treatment may vary depending on the severity of the infection, the type of bacteria involved, and other factors. Intravenous antibiotics may be given initially, followed by oral antibiotics.

How to prevent prosthetic joint infection?

To minimise the occurrence of prosthetic joint infections, a comprehensive approach combining measures before, during, and after surgery is crucial. Following are preventive measures to help mitigate the risk of infection:

Antibiotic prophylaxis: Your doctor may prescribe antibiotics before and after surgery to help prevent infection. It is important to take the antibiotics exactly as prescribed and finish the entire treatment course.
Post-operative care: After surgery, following your doctor's instructions for caring for your incision site, such as keeping it clean and dry, is essential. Maintaining good personal hygiene is vital to reduce the risk of infection. Avoid activities that may strain the joint.
Regular follow-up: Regular follow-up appointments with your doctor to monitor the healing process and identify any signs of infection early.

Book an appointment at Pantai Hospitals

A dedicated and expert team of Orthopaedic specialists at Pantai Hospital is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding prosthetic joint infection. We assure you the best possible care tailored to your specific needs.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.