Hip Replacement Infection: Causes, Symptoms and Treatment

• Infections in hip prosthesis have an incidence of 1% to 3%.
• The most noticeable symptom and the one by which any specialist should rule out prosthesis infection is pain.
• Treatment for hip replacement infection will vary according to the severity of the infection.

The hip prosthesis can become infected with a probability of 1 % - 3 %. The risk of this happening increases with the severity of the patient's associated diseases such as: diabetes, weak immune system, etc.

Although it is very common to think that infections happen in the operating room, this is not always where they originate. As you have read, there are factors that make a person more prone to infection.

To treat it, the specialist will take into account the symptoms you present. Although there are several symptoms associated with prosthesis infection, pain is the main symptom for which any specialist should rule out infection from the outset.

Therefore, depending on whether it has been detected which bacteria has caused the infection and how aggressive it is, one treatment or another will be carried out, which may be: antibiotic-based or, in the event that it is insufficient, resorting to hip replacement surgery.

Hip replacements become infected due to the presence of bacteria. These micro-organisms are part of the environment, so people are in direct contact with them on a daily basis: they are on our skin, on our clothes, on everyday objects and therefore on surgical material.

These micro-organisms fight for their natural space and are prepared to settle and multiply on foreign surfaces, such as prostheses. Therefore, the fact that a hip prosthesis becomes infected does not imply incorrect disinfection of the surgical room or malpractice on the part of the specialist.

The material from which the prosthesis is made is inert and is not bathed by the bloodstream, so our defences cannot fully protect us. Moreover, when antibiotic treatment is administered, the doses do not arrive in the right way.

In most cases, hip replacement infections occur during the surgery, in the operating theatre. But does this mean that the operating theatre has not been properly disinfected? NO.

Although disinfection and surgeon practice are factors before and during surgery, infection does not always occur during surgery.

In fact, we distinguish between three types of infections depending on the time at which they occur, with respect to the time of implantation:

• Acute infection: diagnosed in the first 3 weeks after prosthesis surgery, usually caused by bacteria.
• Subacute infection: usually diagnosed 3 - 4 weeks after hip arthroplasty, and may be detected up to a year or 2 years later.
• Late infection: usually caused by procedures other than the prosthesis. It usually occurs in patients who have had the prosthesis for years and, after undergoing an examination procedure or an intervention, begin to show inflammatory symptoms typical of bacterial sowing.

In cases where the prosthesis infection occurs after surgery (urinary tract infection, bronchitis, etc.), we also refer to a delayed type of infection. In addition to this, there are certain circumstances and diseases that increase the risk of contracting a hip prosthesis infection.

Factors that put a hip prosthesis at risk for infection

The risk of infection after hip replacement is 1 % - 3 %. However, this figure varies and can be much higher (more than 15%) in patients with:

• Diabetes
• Rheumatoid arthritis
• Previous infections
• Weak immune system
• Fractures
• Previous surgeries in which tissues have been damaged or weakened

The symptoms associated with hip replacement infection are:

• Pain
• Red skin and/or warmth in the area
• Oozing
• Fever
• Lack of mobility

The main symptom of hip replacement infection is pain.

In fact, whenever a patient with a hip replacement presents with pain, the first thing the specialist should do is to rule out infection.

If the implant is in poor condition, the options for treating the infected hip prosthesis may vary depending on different factors:

• Level of aggressiveness of the bacteria
• Patient's state of health: the patient's diseases and the quality of the tissues from previous surgeries, devitalised areas, etc. will be taken into account.
• Type of infection: it may be acute, subacute or late, depending on the time elapsed from the prosthetic implant to the manifestation of the infection.

Thus, the specialist may opt for antibiotic treatment or, in the event that this is not sufficient, and even if it is started but has no effect, resort to surgical treatment.

The micro-organism causing the infection of the hip prosthesis will determine the type of treatment to be followed.

In order to remove the prosthesis and replace it, it is essential to have the expertise of a specialist in Orthopaedic surgery. Thus, hip replacement can take two paths:

One-stage hip replacement

One-time replacement arthroplasty is performed when antibiotics are ineffective in patients with hip prosthesis infection.

In this case, complete removal of the implanted elements is performed in a single intervention.

Two-stage hip replacement

In cases of chronic or delayed infection, the prosthesis is replaced in two stages.

In the first intervention, all components of the prosthesis are removed and a temporary spacer with antibiotics is inserted.

Antibiotic treatment is carried out for 2 - 4 months and, after checking that the infection has been eradicated, the new prosthesis is fitted.

If you have a diagnosed case of hip prosthesis infection and you would like to know the surgical assessment of the specialist, Operarme offers you a first consultation free of charge.

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