Joint replacements such as hip and knee surgeries are common procedures aimed at helping patients regain mobility and return to an active lifestyle. Although infections following these surgeries are statistically rare, they remain a significant complication that can be difficult to treat.
Periprosthetic joint infections are particularly challenging because antibiotics often have limited effectiveness near prosthetic hardware. The environment around artificial joints can enable bacteria to thrive, sometimes leading to further surgeries or even revisions of the replacement.
Bacteria can form a protective layer called biofilm on prosthetic surfaces in as little as ten minutes. This biofilm acts as a barrier, making it difficult for antibiotics to reach and eliminate the infection. In addition, bacteria may be carried into surgical sites by airborne particles such as dead skin cells or dust, potentially leading to infection during or after surgery.
Joint infections may also develop long after surgery if bacteria from other sources—such as dental infections, abscesses, or insect bites—enter the bloodstream and settle in the area around the prosthesis. Diagnosing these infections can be complicated due to non-specific symptoms like fatigue, cold-like symptoms, pain, and reduced mobility. There is no single blood test for detection; imaging may help but does not always reveal an infection.
To reduce risks before surgery, doctors assess each patient's health status. Conditions such as uncontrolled diabetes (A1C above 7), obesity (BMI over 40), ongoing use of immunosuppressive drugs, smoking, recent steroid injections in the affected joint, renal dialysis dependence, end-stage liver failure, or current chemotherapy can increase the likelihood of complications. Surgery may be postponed until these factors are addressed.
Once cleared for surgery, several measures are taken to lower infection risk:
- Patients receive nasal sprays that kill bacteria before surgery.
- Surgeons inject antibiotics directly into the bone and provide intravenous antibiotics within an hour before surgery.
- Patients use chlorhexidine scrubs at home prior to their operation.
- Surgical staff wear protective helmet systems with air filters during procedures.
- Dental clearance is required before surgery; patients must take antibiotics prior to dental visits for one year post-surgery.
- For knee replacements, tourniquets help localize antibiotic effects during infusion.
Despite advances in many areas of medicine, outcomes related to orthopedic infections have not improved significantly over the past 25 years due to evolving bacterial resistance. Researchers continue exploring new solutions such as bacteriophages—viruses that target bacteria—and evaluating antibiotic-infused spacers for treating infected joints more effectively.
Ohio State Health and Discovery is involved in research aimed at improving outcomes for joint replacement patients. The organization addresses broader societal issues including health equity and substance use while advancing health care through research innovations and community involvement. It operates hospitals and outpatient facilities as part of its academic medical center model and provides resources on wellness topics through its platform Ohio State Health & Discovery. The institution emphasizes preventive care and education while striving to advance health both locally in Ohio and globally [source].
