Prevention and management of infection after total joint replacement

Prophylactic antimicrobial regimens providing adequate drug levels in tissue during surgery and for periods of 24 hours to 14 days are of proven effectiveness in reducing infection rates after joint arthroplasty. Although most surgeons employ short regimens of <24 hours' duration, their efficacy has not been clearly established for joint replacement in placebo-controlled trials. Careful preparation of the patient before surgery and attention to operating room asepsis are also important. In early postoperative infections, surgical debridement and antibiotic treatment may allow conservation of the prosthetic components. In established infection in which the components have become loose, radical surgical debridement must include removal of all prosthetic material as well as involved bone and soft tissue; reconstruction by exchange arthroplasty has an acceptable success rate. For infections caused by organisms of low virulence, exchange arthroplasty has been successful as a one-stage procedure, but no comparative trial with two-stage exchange has yet been reported.