| Infection remains the most dreaded complication | | | | two doses given within 24 hrs post surgery) have |
| affecting total joint arthroplasty patients. Infections | | | | greatly reduced the incidence of infection. |
| may be superficial or deep. The usual flora in infected | | | | Early evidence of infection can be substantiated by |
| patients are Staphylococus or Streptococcus species, | | | | elevated levels of C- reactive protein (CRP). |
| although cases with Pseudomonas and other hospital | | | | Early infection (less than 3 months post surgery) is |
| acquired pathogens have been reported. | | | | treated with a extensive surgical debridement and |
| Infection should be considered in any patient with a | | | | the implant is retained, if found well fixed. Implant if |
| total joint arthroplasty presenting with acute onset | | | | found loose is removed, and a two stage revision |
| pain in the setting of a previously painless functioning | | | | surgery is planned. |
| joint; or prolongation of the post-operative pain. | | | | Treatment of late onset infected arthroplasty |
| The factors associated with increased risk of | | | | depends on the duration, as well as the microbial flora |
| infection include, skin disease at the operative site, | | | | involved. For chronic infections options include- implant |
| immunosuppression due to systemic illness or | | | | removal followed by two stage revision arthroplasty, |
| prolonged steroid intake, diabetes mellitus, | | | | resection arthroplasty or arthrodesis. |
| concomitant urinary tract infection, previous surgery | | | | In two stage revision arthroplasty, the first step |
| in the same region, and inflammatory arthritis. | | | | consists of removal of all the implants, extensive |
| The use of filtered vertical laminar flow operating | | | | debridement followed by antibiotic impregnated |
| rooms, body exhaust suits, proper operation theatre | | | | cement spacer. The second stage is carried out |
| discipline and prophylactic antibiotics (three doses of | | | | when there is no clinical and laboratory indication of |
| 1st generation Cephalosporin (Cefazolin / Cefuroxime) | | | | active infection. The definitive components are |
| starting one hour before surgery with the remaining | | | | inserted with antibiotic loaded bone cement. |