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Infection & Joint Replacements

INCIDENCE

  • Overall in UK probably > 1%

  • 1.7% in OA; 4.4% in RA (Swedish register)

  • related to type of implant used - higher incidence in hinged or constrained implants

BACTERIOLOGY

Organisms responsible for Deep Joint Sepsis:

Organism   

%

Skin Flora   

Staph aureus   

30

   

Coag -ve staph   

18

   

Corynobacterium   

1

   

G +ve cocci   

1

   

Anaerobic cocci   

1

   

Group B strep   

1

Faecal flora   

E. coli   

3

   

Strep faecalis   

4

   

Pseudomonas   

2

   

Alkaligenes faecalis   

1

   

Proteus   

3

Mixed Flora   

   

9

SOURCES

Intra-operative:

  • Charnley found that sampling of theatre air identified the same organisms & same proportions as the infecting organisms. This has been confirmed by the MRC Trial & Swedish Register.

  • Davis et al. showed a contamination rate of 63% in primary hip & knee arthroplasties, with the surgeons gloves, gowns, light handles, skin blades and needles mainly affected. 76% of the organisms grown were coagulase-negative staphylococcus.

Post-operative:

  • the surgical wound is bacteriologically sealed after 24 hours

  • Drains left for 48 hours allow ingrowth of organisms (Willett et al. JBJS 1988)

  • Haematogenous spread from:

    1. urethral instrumentation

    2. cutaneous lesions

    3. distant sepsis




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