Infection of an orthopaedic implant: Treatment and prevention

For the treatment of a deep infection of an arthroplasty several modalities have been proposed. Besides antibiotic treatment, other treatment options are debridement without removal of the prosthesis, one-stage exchange arthroplasty, two-stage exchange arthroplasty and resection arthroplasty. Less frequently used treatments are arthrodesis or disarticulation. The choice of treatment is influenced by several factors, including the acuteness or chronicity of infection, the infecting organism and its sensitivity to antibiotics, the physical and mental health of the patient, the fixation of the prosthesis, the available bone stock and the professional opinion of the surgeon. Prevention of a deep infection of an arthroplasty remains a key issue. Administration of prophylactic antibiotics peroperatively is probably the single most effective procedure. Other measurements taken to prevent infection are the use of a clean air operating room, antiseptic agents, plastic surgical gowns and drapes; however, their contribution to the prevention of infection is still debated. With respect to the haematogenous spread of bacteria as a cause for infection of an arthroplasty, immediate recognition and eradication of the possible source of infection is extremely important to prevent infection of a joint prosthesis. (C) 2000 Lippincott Williams and Wilkins.