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Active remote-site musculoskeletal infection as a risk factor for periprosthetic infection in a new joint implant: A
Bassem I Haddad1, Jihad Alajlouni1, Mohammad Hamdan1
1Faculty of Medicine, Special Surgery Department, Orthopaedics and Trauma Department, University of Jordan, Queen Rania Street, Amman, 11942, Jordan.
Introduction:
Arthroplasty has always been associated with complications, such as the possibility of periprosthetic infection. The presence of an active infection at the site of the planned surgery is considered a contraindication for the new implant. However, it is unclear whether there is an association between the presence of remote musculoskeletal infection and the development of infection in the prosthetic joint itself. We report six cases involving patients with active ongoing musculoskeletal infections at a remote site who underwent arthroplasty.
Presentation Of Cases:
Four male and two female patients were included in this review. Three patients underwent total hip arthroplasty, one underwent hip hemiarthroplasty, and two underwent total knee arthroplasty. All surgeries were performed in the presence of different stages of infection at a remote site; two had active infections with pus-discharging sinus, one was being treated with long-term oral antibiotic suppression, and three patients were diagnosed with remote prosthetic joint infections on the basis of joint aspiration or intraoperative cultures. Clinical assessments of pain, wound erythema or drainage, and soft tissue swelling were performed at follow-up. Radiography and analysis of inflammatory marker levels were performed preoperatively and 6 weeks postoperatively.
Discussion:
All six patients were followed-up for at least 18 months (mean, 4.6 years; range, 18 months to 9 years). No evidence of superficial surgical-site infection or deep prosthetic joint infection was observed.
Conclusion:
The presence of an active infection at a remote site might not be a contributing factor to periprosthetic joint infection.
Insights
Remote musculoskeletal infections did not lead to periprosthetic joint infections in six arthroplasty patients. This suggests that remote infections may not be a contraindication for joint replacement surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Arthroplasty
Background:
- Periprosthetic joint infection is a known complication of arthroplasty.
- Active infection at the surgical site contraindicates arthroplasty.
- The impact of remote musculoskeletal infections on prosthetic joint infection risk is unclear.
Observation:
- Six patients with active remote musculoskeletal infections underwent arthroplasty (hip or knee).
- Remote infections varied, including discharging sinuses and treated prosthetic joint infections.
- Patients were monitored for superficial and deep prosthetic joint infections post-surgery.
Findings:
- No cases of superficial surgical-site infection or deep prosthetic joint infection were observed in the six patients.
- Follow-up averaged 4.6 years, with a minimum of 18 months.
- No adverse infectious complications related to the remote infection were noted.
Implications:
- Remote musculoskeletal infections may not increase the risk of periprosthetic joint infection after arthroplasty.
- This finding could influence surgical decision-making for patients with concurrent remote infections.
- Further research is warranted to confirm these observations in larger cohorts.
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