Prosthesis infection: specialists and information

Leading Medicine Guide Editors
Author
Leading Medicine Guide Editors

Pain in the region of an implanted artificial joint (endoprosthesis) can be a sign of a prosthesis infection. If treatment is not provided or is provided too late, such an infection can have serious consequences. It is best to discuss the issue with your azrt as soon as possible.

Here you will find further information as well as selected specialists and centers for prosthesis infections.

ICD codes for this diseases: T84.5

Recommended specialists

Article overview

What is a prosthesis infection?

The technique of implanting artificial joints(endoprostheses) has improved steadily over the last few decades. The implantation of artificial joints, such as

is now a routine procedure, especially at specialized clinics. The rapid increase in joint replacement operations in recent years can be explained by improved techniques. However, the general ageing of the population and the desire for mobility into old age is also leading to more and more endoprostheses being implanted.

Despite modern technology, inflammation can occur in the area of endoprostheses. Such an infection of the affected bones and joints, including the surrounding tissue, continues to pose a challenge.

Doctors differentiate between acute and chronic inflammation. Infection of the prosthesis usually occurs during the operation or in the course of the wound healing process. Depending on the location, the infection rate is between 0.5 and 2 percent.

A prosthesis infection is associated with a significant reduction in quality of life for those affected. It requires long, cost-intensive hospital stays and various treatment efforts.

Symptoms of a prosthesis infection

An acute prosthesis infection is characterized by a pronounced feeling of illness. Those affected feel tired and exhausted and suffer from fever and chills. In the area of the prosthesis there is

  • Redness,
  • pain,
  • swelling and/or
  • overheating.

Various symptoms of inflammation can be detected in the blood. Doctors refer to this as sepsis (also known as blood poisoning): This is a serious general infection of the entire organism.

A gradual progression is one of the most important characteristics of a chronic prosthesis infection. It often only manifests itself in the form of relevant symptoms over time, making early detection difficult. Pain in the affected joint and increasing loosening of the prosthesis are the most important signs.

Hüft-Endoprothese
Despite modern implantation procedures, here for example a hip endoprosthesis, prosthesis infections can still occur today © oceandigital | AdobeStock

Prosthesis infection: possible triggers & causes

Bacteria are usually responsible for an infection during the operation or wound healing phase. These can enter the wound area due to a lack of hygiene or the absence of other essential protective and precautionary measures.

Alternatively, bacteria from sites of inflammation can spread to other parts of the body via the bloodstream. Possible triggers here include

  • Skin infections,
  • urinary tract infections and
  • lung infections.

Doctors use three categories to classify the prosthesis infection in question. The classification of a prosthesis infection into one of the categories depends on the time of occurrence.

  • First category: The infection occurs within three months of the procedure. Bacteria(Staphylococcus aureus and gram-negative bacteria) are usually the cause. They enter the body during the operation.
  • Second category: Delayed manifestation of an infection acquired during the operation with primarily coagulase-negative staphylococci. The inflammation appears around three to 24 months after the operation.
  • Third category: Infections that only lead to the first signs of disease after about two years. The cause is usually hematogenous spread, i.e. infections in other parts of the body. Here too, staphylococci are the main cause. Urinary infections caused by Escherichia coli bacteria are an exception.

Examination & diagnosis of a prosthesis infection

If you suffer from one or more of the symptoms described above, you should consult your doctor. If you have a denture infection, only prompt treatment can prevent your condition from worsening with potentially serious consequences.

Your doctor will ask you questions about your symptoms, your medical history and more in an initial consultation, known as an anamnesis. The anamnesis serves as an initial classification of the present illness.

This is followed by a physical and radiological examination. Important findings also include

  • a blood test,
  • a puncture of the affected joint,
  • tissue samples and
  • an analysis of the prosthesis material.

In order to determine potential triggers as precisely as possible, the doctor often also examines the surrounding area, i.e.

If symptoms of inflammation are also recognizable here, a direct link to the denture infection is likely.

Qualified contacts and therapeutic approaches & treatment options

The first point of contact for complaints with your prosthesis is your family doctor or the doctor responsible for your joint replacement. In general, specialists in

are very familiar with this clinical picture. In case of doubt, they will refer you to experienced physicians with the appropriate specialization.

The focus of therapeutic efforts is on surgical intervention aimed at replacing the prosthesis. This means that the infected prosthesis must be removed - and a new one inserted.

The second component of promising treatment for prosthesis infections is long-term antibiotic therapy.

The so-called two-phase method generally promises better results. The first step is to remove the infected prosthesis.

This is followed by six weeks of antibiotic therapy, accompanied by strengthening of the joints using antibiotic-impregnated spacers.

Only then is the new prosthesis inserted. This measure is concluded with a further course of antibiotics over a period of six weeks.

Progression & prognosis: final considerations

There is a risk that a prosthesis infection will take an unfavorable course, particularly in the case of infections caused by staphylococci.

Even in the case of septic prosthesis loosening, the chances of a complication-free recovery are rather low. A minimal infection is sufficient for this. As described above, treatment here is also "two-stage" with a combination of

  • Removal of the prosthesis,
  • joint rehabilitation,
  • antibiotic therapy and
  • subsequent implantation of a new prosthesis.

Bone grafting may also be necessary to compensate for the loss of bone substance due to loosening.

In summary, it should be noted that prosthesis infections are rare. However, due to their potentially serious consequences, they must be taken very seriously.

The most important preventive measures include

  • Absolute hygiene,
  • sterility,
  • a healthy diet and
  • immediate medical consultation in the event of a bacterial infection, for example in the mouth and teeth.

References

  • Eulert, J./Frommelt, L./Hendrich, C.: Septische Knochen- und Gelenkchirurgie, Springer-Verlag, Berlin 2012.
  • Otto-Lambertz, C. u.a. (Hrsg.): Periprothetische Infektionen beim Gelenkersatz in: Deutsches Ärzteblatt 2017 (Link, abgerufen am 12. 12. 2021).
Whatsapp Facebook Instagram YouTube E-Mail Print