Infections arising from hip replacement surgery

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Background to Hip Replacement Surgery:
 Although a common procedure, for most patients it is still filled with anxiety. These infections are associated with hip replacements.

Infections

Infection after the surgery is of three varieties.

Superficial infection: This involves the coverings of the hip joint without extending into the joint itself. In a patient having a superficial infection, the wound leaks fluid excessively and skin around the surgical cut looks red and inflammed. The patients generally do not feel unwell in themselves. The infection can frequently be treated successfully by antibiotics.

Deep Infection: Infection may also be of the deep type which is more serious as it extends down to the artifical hip joint. A patient developing this complication is likely to feel unwell and have a temperature in addition to having an inflammed red wound which leaks fluid or pus. The hip may be painful and walking may make the pain worse.

With this type of infection your specialist is likely to recommend surgery to wash out and clean the infection and also put you on intravenous antibiotics. Sometimes it is necessary to operate again to clean the infection a second time. The antibiotics will generally be continued for a period of 6 weeks and many infections can be cured successfully in this manner. Ocasionally deep infection may not respond to this treatment and will then require to be treated as a late infection

Late infection: This is deep infection that develops later than about 12 weeks after the surgery. Usually, this type of infection will not respond to antibiotics and operations to wash out the infection. This is because the germs that cause the infection get into tiny crevices of the artifical hip itself rather than just remaining in the living tissues. As the blood does not flow into the artifical joint, the antibiotics do not reach the germs and are therefore not very effective.

The best chance of curing the infection is by removing the artifical hip completely to wash out the infection and using antibiotics put directly inside the hip joint space and also given intravenously. It is usually necessary to wash out the infection at least twice and continue the antibiotics for 6 weeks. During this time the patient has no hip joint at all but is generally able to get about in a limited manner with the aid of two crutches.

The specialist is likely to carry out serial blood tests the results of which can give him some indication of whether the infection is being cured. At about 8 or 9 weeks after the start of the antibiotics, it will be necessary to put a needle into the hip joint under X-Ray control to remove a sample of fluid. This is examined in the laboratory for any persistent infection and if none is found, that is a good indicator of the infection having been treated successfully.

The specialist will however also take into account the results of the blood tests and his physical assessment of the hip to advise the patient whether the infection has been eliminated. Once the infection has been successfully cleared, the specialist will recommend a waiting period before proceeding to implant a new hip. This can vary from a few weeks to a year. The length of this waiting period depends upon a number of factors including the type of germ that had caused the original infection and the state of the patients health and his or her ability to undergo a further major operation.

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