Periprosthetic Total Hip Infection

Patients with artificial joints: do they need antibiotic cover for dental treatment?

“…1,6,[8][9][10] It is important that all papers which set out to document joint infections have meticulous methodology as it is easy for the source of the infection to be based on anecdote. Ideally, to confirm that an implant has been infected from an oral treatment, one requires a coincidence history and an accurate and simultaneous typing of the oral flora bacteraemia and joint organisms.…”

“…8,9 All require intensive and prolonged treatment. In one study of a consecutive series of infected hip replacements, 58 per cent were successfully re-implanted with a further artificial joint after a resolution of the infection, 34 per cent had implant removal but no replacement but local tissue flaps; 4 per cent had leg amputation at the level of the hip and 5 per cent of the patients died.…”

“…9 Infections in joint replacements are divided into early or late occurring. 8,9 Early infections, that is within the first three months following implantation, primarily relate to infection introduced at the time of the operation, either sourced from the patient or the surgical staff. The incidence of this is low and of the order of 0.39 per cent.…”

“…If the patients have a type I allergy to penicillin or cephalosporins, or if they are at high risk for MRSA colonization or infection, vancomycin should be used instead of cephazolin. 8,9 The operation should be performed by experienced surgical personnel in a dedicated operative suite (Figs 2a and 2b). The theatre should be equipped with vertical laminar flow units or at the very least be a high flow theatre.…”

“…In general there are significantly greater and more complex problems associated with the management of failed artificial joints than with the primary placement. 8,9 Revision surgery has a much higher risk of complication including infection and an increased mortality risk.…”