Infected joint arthroplasty

Infection following total joint replacement occurs most frequently in certain groups, including patients with rheumatoid arthritis or diabetes mellitus and those who are immuno suppressed. Prophylaxis is the main weapon against infection and the methods available include improved impermeable surgical clothes, clean air, and antibiotics. Single-shot antibiotics can be given before total joint replacement. Other methods, such as giving the antibiotic in the bone cement and low-viscosity cement to produce a slow release of the antibiotic gentamicin, have been tested. There is still a great deal of controversy about the role of antibiotics in patients undergoing dental treatment. The view is presented that although there is no evidence that patients develop infection directly from dental treatment, there are patients at risk for infection (eg, the immuno suppressed patients), and antibiotics should be given to these patients. Leukocyte scans are advocated for detecting infection in bone. Patients who have infected total joints do not appear to benefit from single debridement and prosthetic retention. (C) Lippincott-Raven Publishers.