Prosthetic Joint Failure and Infection | Dr Thomas Hilton | Bone Tumour Specialist | Cape Town

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Prosthetic Joint Failure and Infection

Prosthetic joint failures and infections can significantly impact mobility and quality of life. Dr Thomas Hilton offers expert diagnosis and comprehensive management, including revision surgeries and infection control strategies, to address these complex challenges.

Understanding Prosthetic Joint Issues

Prosthetic joint infections occur when bacteria or other pathogens infect a joint replacement. Acute infections typically develop soon after surgery, while chronic infections may occur months or years later. Symptoms may include pain, swelling, warmth, drainage, and difficulty moving the joint.

Key points:

Acute infections may require urgent surgical cleaning (debridement) and antibiotics.
Chronic infections often involve removing the infected prosthesis and replacing it in a staged process.
Diagnosis includes blood tests, imaging, and joint aspiration to identify the infection.
Early treatment is critical to preserve joint function and prevent further complications.

Aseptic loosening occurs when a prosthetic joint implant becomes loose without the presence of infection. This can happen over time due to wear, bone loss, or poor initial fixation, leading to pain and instability.

Key points:

Symptoms include increasing pain, stiffness, and difficulty using the joint.
Diagnosis involves X-rays, CT scans, or MRI to assess the implant and surrounding bone.
Treatment may require revision surgery to replace or refix the prosthesis.

Periprosthetic fractures are breaks in the bone surrounding a joint replacement. These fractures are often caused by trauma or weakened bone around the implant and can significantly affect mobility.

Key points:

Symptoms include severe pain, swelling, and deformity around the joint.
Treatment depends on the severity of the fracture and may involve stabilisation with plates or screws, or revision surgery.
Bone quality and implant stability are key factors in deciding the best course of action.

Treatments and Procedures

Managing infected joint replacements is a specialised process aimed at removing infection while preserving joint function. Treatment typically involves a staged approach with surgical debridement, antibiotic therapy, and re-implantation.

Key points:

First stage: Removal of the infected implant and placement of an antibiotic spacer.
Second stage: Re-implantation of a new prosthesis after infection resolution.
In some cases, single-stage revision may be considered depending on the infection severity.

Custom prostheses are tailored to fit a patient’s unique anatomy, often used in revision surgeries for complex cases. These implants provide enhanced stability and functionality when standard implants are insufficient.

Key points:

Designed using advanced imaging and CAD (computer-aided design) technology.
Ideal for cases with significant bone loss or unique anatomical challenges.
Promotes better fit, function, and durability.

Non-invasive joint reconstruction techniques are innovative approaches that minimise the need for extensive surgical intervention. These techniques focus on preserving existing structures while addressing joint issues.

Key points:

Includes technologies like electromagnetic bone growth stimulation and minimally invasive procedures.
Helps improve bone healing and reduce recovery time.
Often used in conjunction with traditional surgery for optimal outcomes.

Revision arthroplasty is the replacement of a previously implanted joint prosthesis due to issues such as wear, loosening, infection, or mechanical failure. This is a complex surgery requiring careful planning to restore function and stability.

Key points:

Common reasons for revision include infection, aseptic loosening, or implant wear.
Involves removing the old implant and replacing it with a new one.
May require additional bone grafts or custom implants in complex cases.
Focuses on alleviating pain and restoring joint movement.

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