Related Experiment Video
Updated: Apr 28, 2026
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
[Infections associated with orthopaedic devices]
Abstract:
Surgical site infections are a major complication of instrumented orthopaedic surgery, affecting 0.5 to 2% of patients following arthroplasty, and up to 30% of patients after fixation of open fractures. Acute infections may result from exogenous inoculation during or in the weeks following surgery (early infections), or from hematogenous seeding from a remote origin at any time after implantation (late infections). These infections are generally due to virulent organisms, such as Staphylococcus aureus, and must be treated rapidly. Delayed infections, arising between 3 and 24 months after surgery, are caused by low-virulence organisms such as coagulase-negative staphylococci. Diagnosis of delayed infections may be difficult because clinical presentation is often subtle and limited to chronic pain, and relies on imaging studies and culture of synovial fluid aspirates. Strong collaboration between surgeon, microbiologist and infectious disease specialist is essential for management of implant-associated infections, which almost always necessitates surgical intervention and prolonged antimicrobial therapy. The choice of the type of surgical intervention (debridement, or removal with or without exchange of the implant) depends on the duration of infection signs, on the pathogen species and antibiotic susceptibility, and on the patient general and local condition. Antibiotics are chosen according to pathogen susceptibility and to pharmacokinetic parameters such as bioavailability and penetration into the bone tissue. Patients treated in accordance with current guidelines are cured of their infection in 60 to 80% of cases.
Insights
Surgical site infections (SSIs) are a significant risk in orthopaedic surgery, impacting patients undergoing arthroplasty and fracture fixation. Prompt diagnosis and multidisciplinary management, including surgery and targeted antibiotics, are crucial for successful treatment outcomes.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Microbiology
Context:
- Surgical site infections (SSIs) are a major complication in instrumented orthopaedic surgery, with incidence rates varying from 0.5–2% after arthroplasty to 30% after open fracture fixation.
- Infections can be acute (early or late) or delayed, caused by different pathogens (e.g., Staphylococcus aureus, coagulase-negative staphylococci) and presenting with diverse clinical signs.
- Delayed infections, often subtle and challenging to diagnose, require advanced imaging and microbiological analysis.
Purpose:
- To outline the epidemiology, classification, and diagnostic challenges of surgical site infections in orthopaedic implant procedures.
- To emphasize the critical role of interdisciplinary collaboration among surgeons, microbiologists, and infectious disease specialists in managing these complex infections.
- To detail the treatment strategies, including surgical interventions and antimicrobial therapy, based on pathogen characteristics and patient factors.
Summary:
- SSIs are a significant complication in orthopaedic surgery, with varying incidence and causative organisms.
- Diagnosis of delayed infections can be difficult, necessitating advanced imaging and fluid cultures.
- Management requires a multidisciplinary approach, combining surgical intervention with prolonged, targeted antibiotic therapy.
- Treatment success rates, guided by current protocols, range from 60% to 80%.
Impact:
- Improved understanding of SSI pathogenesis and clinical presentation in orthopaedic patients.
- Highlights the necessity of a collaborative, evidence-based approach for optimizing patient outcomes.
- Provides a framework for selecting appropriate surgical and antimicrobial strategies, potentially reducing morbidity and improving cure rates.
Related Concept Videos
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:25Endocarditis I: Introduction
01:30Bacterial Signaling
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:20Infection
The chain begins with pathogens: bacteria, viruses, fungi, prions, or parasites such as protozoa helminths. These can be present on the skin as transient or resident flora, or they can be acquired from the environment. Identifying and treating the type of infection and...