Etiopathogenesis: All over the world 1 million prostheses, including knee and hip prostheses, are performed in one year, and periprosthetic infection occurs in approximately 1% of these surgeries. The number of infected prostheses is increasing every year. And it is predicted that it will become a serious health problem in the next 10 years. For this reason, as in the rest of the world, in our country, first, protective precautions for protheses are applied, and although this precautions are applied, some of patients encounter the infectio. Therefore, the treatment of infected prostheses is very important.
Clinical: The diagnosis of infected prosthesis is made by clinical, laboratory tests and joint aspiration. Patients diagnosed in the first 3-6 weeks are called acute periprosthetic infection, and those diagnosed after the 6th week are called late infection. In acute infections, the patient presents with pain, redness and swelling in the prosthesis area. In late infection, the patient presents with a discharge or a skin wound that is associated with the joint called a fistula. In both cases, the patient presents with pain, inability to walk, and limitation in daily activities.
Diagnosis: CRP, sedimentation and Leukocytes are highly elevated in both acute and chronic prosthetic infections and are helpful in diagnosis. However, the definitive diagnosis is made by showing the presence of microorganisms in the joint by performing joint aspiration. Usually Staf Aureus grows in culture. In addition, Leukocyte esterase test and ∝-Defensin tests help between 90-95% to confirm the diagnosis.
Treatment: Early treatment increases the chance of success in acute prosthetic infections. 90-100% success is achieved with the removal of all infected tissues by opening the joint, washing with plenty of serum and replacing the insert, and 3-6 weeks of antibiotic treatment given in accordance with the microorganism found. In chronic infections; two-stage treatment should be done. In the first stage, all prosthesis material should be removed, all infected tissues should be removed by debridement, and the joint should be completely cleaned by washing with plenty of serum. After that, a temporary prosthesis, called a spacer, which is mixed with antibiotics, is placed. These temporary prostheses can be either mobile or fixed. The selection of therapy method will be done according to the condition of the patient and the bones and ligaments in the joint. After this surgery, antibiotic treatment is given for 3-6 weeks depending on the microorganizm found. If CRP, sedimentation and Leukocyte values return to normal or near-normal values after 6 weeks of antibiotic treatment and 2 weeks of waiting, joint aspiration is done. If the microbe does not grow in the joint aspiration performed 2 times in a row, the second stage can be started. However, it is recommended not to pass this stage before 3 months in terms of the general health status of the patient. In the second stage surgery, the spacer is removed and the joint is cleaned again. In the meantime, the absence of microbes in the joint histological examination (frozen) helps in the decision to put a new prosthesis. If microbes are seen in this examination, the first stage procedures are repeated. In the second stage, if it is decided that the joint is clean, prostheses called revision prostheses that enable both bone and ligaments to be reconstructed should be used.
After this surgery, the patient should be followed closely for recurrence of infection for 3-6 months.
Patient 1: We applied a two-stage treatment to a patient who had total knee prosthesis 2 years ago and who developed an infection around the prosthesis after a short time and was operated 3 times in another hospital for this reason. In the first stage, the prosthesis was removed and we applied spacer treatment with antibiotics. After seeing that the infection was gone, we performed a reconstruction with a tumor prosthesis to compensate for the severe bone loss in the second stage.
Patient 2: Pictured is the result of two-stage treatment in another patient who developed an infection after hip replacement.