"There are very few things that improve quality of life as much as joint replacement, but 1 to 2 percent of the time the new joint can become infected, even when precautions are taken," said Douglas R. Osmon of Mayo Clinic. "There are many different ways to treat these infections to achieve the same outcome. The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient."
Hips, knees and other joint replacements – such as shoulders and elbows – can become infected during the surgery or months or even years later. The guidelines outline the evidence and opinions regarding methods that are appropriate to diagnose the infections early and treat them most effectively, according to patients' specific situations. Most infections require long courses of antibiotics and surgery, which can range from washing out the infected area to removal and replacement of the joint to permanent removal of the prosthesis to amputation.
Multidisciplinary teams should include an orthopedist and an infectious diseases specialist, as well as other specialists on a case-by-case basis. For instance, if the patient is older and has heart disease, an internist should be involved, and if the surgical wound is difficult to close, a plastic surgeon should be consulted, said Osmon. In rural areas with few specialists, doctors should consider consulting with infectious diseases specialists or orthopedists at referral centers.
"The number of people suffering from prosthetic joint infections will continue to grow because, although we are getting better at preventing infection, that is countered by the increase in older and sicker people having joint replacement," said Osmon.
Of the one million people each year who get hips and knees replaced, as many as 20,000 will get an infection in the new joint, a number that is expected to skyrocket in the next 20 years.
MEDICA.de; Source: Infectious Diseases Society of America