Bone Infections & Joint Replacement

Dallas Ft. Worth Sarcoma Group's Approach to Infected Joints

Infections of bones and joints are serious problems because joint cartilage and bone can be irreversibly damaged by infections. Treatment of bone infections (osteomyelitis) and joint infections (septic arthritis) may require antibiotics and sometimes surgery. Infecting organisms, mainly bacteria, usually reach the joint through the bloodstream, but a joint can be infected directly if it is contaminated during surgery or an injury.

Dr. Maale is a fellowship-trained orthopaedic surgeon specializing in the treatment of infected orthopaedic implants. Infected implants are one of the most common scenarios encountered at DFW Sarcoma, and the staff at the practice are highly specialized in treating bone and implant infections.

How Joint Replacements Become Infected

While joint replacement procedures are meant to alleviate pain and improve range of motion, they also have a tendency to become infected by certain strains of bacteria if certain preventative measures aren't taken. Joint replacement infections occur because the orthopedic implant materials allow bacteria to endure even as the immune system attacks the infection.The body has difficulty attacking bacteria that attaches to implants. This becomes a serious issue, as the immune system has difficulty eliminating the bacteria from the joint replacement material.

Bone Infections - Treatment

After injury, treatment needs to be immediate. The body has a hard time fighting bone infections because of a lack of immuno-defense within bone and joint cavities. Joint fluid is withdrawn with a needle to remove pressure and to be tested. Antibiotic treatment usually begins immediately to prevent further damage or infection.

It may also be necessary to continuously drain the infected joint space, either by washing out the joint with sterile solutions, (arthrocentesis or surgical irrigation) or removal of decaying tissue (debridement). There may be significant joint damage resulting from septic arthritis that eventually leads to joint replacement surgery.

Methods of Prevention During Joint Replacement Procedure

Dallas Ft. Worth Sarcoma Group is comprised of joint replacement and osteosarcoma specialists who give due diligence to every joint replacement procedure performed and ensure that the joint replacement is performed in a clean and sterile environment. At the time of surgery, DFW Sarcoma implements these known methods of preventing infections in the operative joint:

• Antibiotics before and after surgery - antibiotics are prescribed because they help prevent bacteria from traveling through the bloodstream, and are typically given approximately one hour before surgery and continued for a short time after the procedure
• Efficiency in the operating room - DFW Sarcoma's expertise in the operating room contributes to short operating time and minimal OR traffic - two tactics that are thought to minimize the amount of bacteria exposed to an operative joint
• Strict sterilization techniques - DFW Sarcoma uses preventative measures such as maintaining sterile instruments, a sterile operating site, and keeping the orthopedic implant in its packaging until placement to ensure its cleanliness

Bone & Joint Replacement Surgery

Joint surgery can relieve pain and restore function. Although each year orthopedic surgeons at DFW Sarcoma perform many arthroplasty or joint replacement surgeries, the decision to undergo joint surgery must follow careful consideration. Total joint replacement is a type of joint surgery where the damaged joint is removed and replaced with an artificial joint (prosthesis or implant.)

Surgical Cleaning of the Joint

If an infection has only been present for a short period of time, it may be possible to “wash out” the joint. This is often referred to as “irrigation and debridement.” This surgery usually involves cleaning the joint out by removing any infected tissue and washing a large amount of saline and antibiotics through the wound. Some infections may be treated with an arthroscopic washout. Arthoscopic washout means that a small incisions and an arthroscope (a thin flexible fiberoptic scope or tube) may be used for the procedure.

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