Infection after total joint arthroplasty from distal extremity sepsis

At the UCLA Medical Center in three patients treated for hematogenous infection after total joint arthroplasty, the source was apparently an infection in the extremities at a site distal to the joint arthroplasty. In a 72-year-old woman with rheumatoid arthritis infection developed in the right hip after total hip arthroplasty following a Staphylococcus aureus infection at the site of a left metatarsophalangeal arthroplasty. In a 64-year-old man with osteoarthritis the staphylococcal infection that developed after right total hip arthroplasty was seeded from a pyarthrosis of the right knee. In a 61-year-old woman with rheumatoid arthritis the sites of bilateral knee arthroplasties were seeded from a soft tissue infection of the left foot. These cases illustrate the potential for infection from local wound sepsis distal to joint arthroplasty. Such infections, particularly in patients with rheumatoid arthritis, should be treated aggressively to avoid seeding of the more proximal total joint arthroplasty site.