Knee joint replacement is a major surgical procedure and, because of the nature of the surgery, it carries with it the potential for post-operative infection. Infection is considered a significant complication due to the artificial replacement components inside the body, which are often secured with a special "bone cement." This makes delivery of helpful antibiotics to an area void of blood supply (metal and plastic) difficult at the least. Infection can further manifest itself in different levels of severity. The vast majority of cases will be treated in a hospital environment; however, some lesser, superficial infections may start out being treated outside the hospital setting.
Steps in treating the infection
Step 1
Understand the type and virulence (nastiness) of the offending organism. This is accomplished through cultures of the wound and physical assessment. In early infections without wound openings, it is often possible to treat with antibiotic therapy. Understand the bug, and you can tailor make the treatment
Step 2
Start taking oral antibiotics in cases of early, mild and superficial infections. Obtain a prescription from your doctor. You may be required to take it anywhere from one to four times a day depending on the drug itself. For example, an antibiotic called Duricef is typically given twice a day, where some doses of Keflex may be given up to four times a day (see Resources).
Step 3
Cleanse wounds in more established infections with tissue breakdown. Typical solutions used in these instances can include betadine and chlorhexadine, which also double as surgical prep solutions (see Resources). This treatment may require mechanical scrubbing of the incision. Packing the wound may also be needed for more extensive openings.
Step 4
Get to the hospital for treatment of deep infection. At this level, antibiotics will be administered intravenously. Establish access by starting an IV with a #18 angiocath (preferable). Hang and connect the "piggyback" bag you receive from the pharmacy to the existing IV and run it until infusion is complete. Repeat as ordered.
Step 5
Remove the implants for advanced sepsis (infection). As discussed earlier, knee replacement parts have no blood supply to allow for antibiotics to reach the infected interfaces between implant and bone/tissue. This usually mandates complete removal of all components. No new implants can be inserted at this stage, until the infection has been completely eradicated and serial cultures are negative.
Step 6
Utilize antibiotic spacers after implant removal. Relatively new on the market are silicone "molds" shaped like joint replacement components. These molds can be filled with antibiotic-impregnated bone cement and fashioned to resemble original component parts (see Resources). The spacers fit like the original parts. The cement molds slowly release the antibiotic mixed into it over time.
Tips and Warnings
- Keep an eye on the incision for any changes in color or temperature. Notify your doctor immediately if any such changes occur or if pain develops with redness. If packing a wound, maintain sterile technique. Take oral antibiotics exactly as directed and for the proper duration.
- Don't pick any scabs around the surgical incision. Don't ignore unusual symptoms such as sudden pain or swelling or feelings of malaise (flu-like symptoms). Do not undergo any dental or surgical procedures without proper antibiotic coverage.
Things You'll Need
- Gauze dressing kits
- Sterile gloves
- Surgical face masks
- Protective gowns
- Sterile gauze packing
- Oral, intravenous antibiotics (as prescribed)
