Publicador de contenidos
Back to opinion_2013_09_25_infeccionprotesica
José Luis del Pozo, specialist of the area of Infectious Diseases of the Clínica Universidad de Navarra
Joint prostheses (knee, hip, shoulder,...) have been a great health advance that has greatly improved the quality of life of our patients. In Spain about 30,000 prostheses are fitted every year. Infection associated with joint prostheses (IPA) is the most severe complication, as it often requires long and complex treatments, and also has a high associated morbidity (implant removal, loss of function, amputations) and, therefore, an increase in health care costs.
Fortunately, its incidence is leave, and ranges around 2% of primary knee and hip arthroplasties.
The microorganisms that cause this infection subject are usually part of the skin flora. There are several classifications depending on the time of onset and the clinical context. The most important are: early postoperative infections (35%) and late chronic infection (50%), which appears at least one month after surgery, and which is the one presented by Don Juan Carlos. The latter is characterized by larval symptoms, usually in the form of isolated mechanical or inflammatory joint pain, without other signs suggestive of infection. These infections are caused by pathogens that are not very virulent.
The approach to PPI should be multidisciplinary, involving traumatologists, infectologists and microbiologists. Thus, questions related to antimicrobial therapy, such as the correct choice, dose, duration, route of administration or the need for combined treatment, have no answer final, hence the importance of individualizing treatment, which goal should seek to eradicate the microorganism without impairing the functionality of the prosthesis and the patient's quality of life. Finding a balance between aggressive therapy and the patient's well-being is not always feasible. In this case, the removal of the prosthesis is fundamental, but the correct antibiotic treatment is no less important, which can last from a minimum of eight weeks to a lifetime when the two-stage replacement fails.