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Infection in orthopaedic implants.

P J Sanderson1

  • 1Department of Microbiology, Edgware General Hospital, Middlesex.

The Journal of Hospital Infection
|June 1, 1991
PubMed
Summary
This summary is machine-generated.

Preventing joint implant infections requires understanding common pathogens like Staphylococcus aureus and implementing effective antibiotic strategies. Diagnosis and prophylaxis remain challenging, necessitating further research into optimal treatments and preventative measures.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Biomaterials Science

Background:

  • Joint implant infection rates exceed 1.0% in some procedures, potentially due to anatomical factors and design experience.
  • Common causative organisms include Staphylococcus aureus, S. epidermidis, coliforms, and anaerobes, with variations between hip and other joint implants.
  • Distinguishing infection from loosening is clinically challenging, though erythrocyte sedimentation rate (ESR) can indicate infection.

Purpose of the Study:

  • To review the challenges in diagnosing and treating joint implant infections.
  • To discuss the role of antibiotics in managing deep joint infections and prophylaxis.
  • To identify areas of uncertainty in current prophylactic strategies for implant infections.

Main Methods:

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  • Literature review and synthesis of current knowledge on joint implant infections.
  • Analysis of etiological agents and diagnostic challenges.
  • Discussion of antibiotic treatment efficacy, penetration, and prophylactic measures.

    • Main Results:

    • Antibiotic therapy alone is unlikely to cure deep infections, but can suppress them in non-operative candidates.
    • Bacteriological diagnosis via aspiration is crucial; broad-spectrum antibiotics targeting S. aureus and S. epidermidis are recommended when diagnosis is absent.
    • Antibiotic penetration through the implant/cement interface membrane is critical but not well-understood.

    Conclusions:

    • Effective management of joint implant infections requires accurate diagnosis and appropriate antibiotic selection, considering penetration capabilities.
    • Significant uncertainties exist regarding antibiotic-impregnated cement efficacy, the need for prophylaxis against hematogenous infections, and skin staphylococcal carrier site management.
    • Further research is needed to optimize antibiotic strategies for both treatment and prophylaxis to reduce joint implant infection rates.