An aging population that’s expected to drive up the number of joint replacement surgeries in the coming years has prompted a specialist group to develop new guidelines to treat the estimated 1% to 2% of patients whose prosthetic joints will become infected.
“There are many different ways to treat these infections,” Douglas Osmon, MD, lead author of the guidelines, said in a statement. “The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient.”
Multispecialty teams should include orthopedic surgeons, plastic surgeons, infectious disease specialists, and internists to provide optimal care, state the guidelines, which were developed by the Infectious Diseases Society of America and released online today in Clinical Infectious Diseases.
Prosthetic joint infections can be difficult to diagnose, noted Osmon, an associate professor in the infectious diseases division at the Mayo Clinic, Rochester, Minn. The guidelines advise physicians to suspect infection if patients have persistent wound drainage over the prosthesis; sudden pain around the prosthesis; or chronic pain that develops within a few years after surgery, especially in patients who have been pain-free for some time or had previous wound healing problems.
Treatment options, depending on patients’ individual circumstances, include debridement, replacing the prosthesis, or removing it. Only as a last resort should physicians consider amputating the limb. Four to 6 weeks of intravenous or highly bioavailable oral antibiotic therapy usually is needed for successful treatment.
“Although we are getting better at preventing infection, that is countered by the increase in older and sicker people having joint replacement,” Osmon said. The guidelines note that the number of total knee replacement and total hip replacement surgeries is expected to quadruple, to 4 million, by 2030.