Infection and Total Hip Replacement: No thank you!

Infection after total hip replacement can be a serious complication, it is worth understanding why and how infections occur.

Here is some general information on how they arise, what you can do to avoid them, and the treatment for them if they do happen.

First, the chances of infection in your new hip is about 1 in 100 according to The American Academy of Orthopedic Surgeons. But they can happen …

- - As a result of bacteria being introduced during surgery
  - After full recovery and as a result of bacteria being introduced into the blood stream. This can happen following procedures like dental work or a colonoscopy.

Because the prosthesis does not have a blood supply it does not have the advantage of the immune system’s ability to fight bacteria. If bacteria finds its way to the prothesis it can adhere and grow. Antibiotics are taken prior to procedures like dental work or colonoscopies to keep bacteria from entering the blood stream and finding their way to the prothesis.

It is worth taking antibiotics during these dental work or colonoscopies to avoid infection because if you do get an infection at the site of your new hip it may require surgery. Something we all want to avoid!

The treatment of an infected hip joint depends on the severity of the infection; the longer you wait before you seek help, the more problematic it can become. For this reason IF YOU THINK YOU HAVE AN INFECTION SEE YOUR SURGEON RIGHT AWAY.

To determine whether you have an infection, your surgeon may use X-rays or blood tests. He/She/They may also draw fluid from the joint and examine it for a large quantity of white blood cells which would indicate that the joint may be infected.

If you have a “Superficial Infection” — which affects the skin and tissue around the joint — and it has not spread deep into the joint then treatment with antibiotics usually resolves the infection

If you have a “Deep Infection” – which has penetrated into the joint — then surgery is usually required.

If the deep infection is caught early then “debridement” often works. This means that the surgeon cleans out all infected tissue, thoroughly cleans the prosthesis, and prescribes antibiotics.

If the deep infection has been present for a long time then “staged surgery” may be required. The stages are:

1) The surgeon removes the prosthesis, cleans out the area, puts in an antibiotic spacer, and prescribes IV antibiotics
2) The spacers contain antibiotics which treat the site. They are in place for about 6 weeks.
3) Once it is determined that the infection is gone there is a final surgery where the surgeon will remove the antibiotic spacer, clean out the area again, and replace the prosthesis.

Infection of the incision as well as infection of the Implant both show signs and symptoms that are similar to other kinds of infections.

Infection signs and symptoms include:

- - Increasing redness around the incision
  - Increasing pain
  - Pus or other fluid coming from the incision
  - Warmer than usual skin around the incision
  - Increased pain around the incision
  - Fever
  - Fatigue

Infection within the joint will likely be accompanied by increasing pain in the joint and may include some of the above symptoms. Joint infections can occur days to years later. Infections in the incision usually occur within a few days of surgery, while the skin is healing.

“Even after a successful operation, patients remain at risk for infection from transient bacteria entering the bloodstream. Because of this, joint replacement patients should take antibiotics before common but invasive procedures such as dental work or colonoscopies.” – Joint Replacement Infection, A serious and dangerous complication after joint replacement surgery

Update June 7, 2024: Since the writing of this blog a new study has come out suggesting that the health of our gut biome can influence bone health and the risks of infection. “… the gut microbiota influences gut permeability and the potential for bacterial translocation to the bloodstream, increasing susceptibility to periprosthetic joint infection.” Find a link to the study below.