Infected hip and knee prosthesis: Advances in diagnosis and treatment.

Infection of a knee or hip arthroplasty is a frightening complication that constitutes a serious drawback for the whole intervention. Just a few years ago It was considered as a real tragedy existing great concern about further function and prognosis. Currently there has been a definite progress in this field mainly due to the following essential issues: 1) Early diagnosis. 2) Bacteriological cultures before intending any antibiotical treatment.

Definition: Peri-prosthetic infection is an infectious disease arising from a superficial colonization of a biological agent over an endoprosthetical surface. This process extends to surrounding bone and soft tissues producing a fistula. Blood stream involvement is followed by a septicemia. Source of infection : Bacterial microorganisms may be endo or exogenic. Infections ocurring during the first year postoperatively are occasioned by exogenic pathogens coming from patient's skin, or surgical environment. On the other hand, infection may arise from an odontological or tonsilar focus, after genitourinary or gastrointestinal procedures or infection. Prosthetic infections may classify into acute or chronic, hematogenous and those presumptively mechanical with per-operative diagnosis of infection.

Diagnosis is established on the grounds of bacteriological and anatomopathological study of periprosthetical and articular percutaneous samples.

Surgical treatment should be considered on an individual basis. Careful planning in one or more stages should be indicated.