Interviewer:
Hi Dr. Amanatullah! How are you doing?
Dr. Derek Amanatullah:
I am great.
Interviewer:
Pleasure to have you back! We’re going to talk today a little bit about infections that can happen during replacement surgery. So how often do you infections occur during a joint replacement surgery?
Dr. Derek Amanatullah:
Yes it’s a really interesting question. Actually infections themselves are pretty common if you look at the reasons why joint replacements fail, but overall they’re not that common. The bigger thing that drives infections is actually the health of the patient. What I want you to imagine is that a person of normal health getting a joint replacement, maybe just has a little bit of high blood pressure, really has a very low risk of getting an infection because we clean our hands, the implants, room, the patient, everything is as clean as possibly can be.
There’s a very small probability that some bacteria could be left from that cleaning process, and that will be the only possible way that bacteria can infect the patient.
But as you get less healthy, so say you have an organ transplant or say have diabetes or obesity or other things that are known to compromise the immune system, then even if we get rid of those bacteria, that one little bacterial left has a liar higher likelihood of surviving, and that can change the likelihood of getting an infection.
So I would say it depends on medical comorbidities and can range from almost nonexistent all the way to really really relevant, hovering around maybe twenty percent of the patients that we operate on.
Interviewer:
Oh wow! So when a joint gets infected, what’s actually going on in the joint when that happens?
Dr. Derek Amanatullah
Yes, so ,what happens is couple of things. First thing that happens is the bacteria need to grow like they would anywhere. So you got a pneumonia, the bacteria would grow inside of your lung.
It’s very interesting because the implant is there, the bacteria can actually set up little cities called biofilm, and that biofilm is actually a living organism where the bacteria communicate with each other. And they can actually live on the metal — they can actually live on the metal such that even if I give you antibiotics, we can’t kill the bacteria. And that’s a very interesting phenomenon that occurs. It probably occurs in other places body too, but it’s very much relevant with respect to implant infections.
So what’s happening inside the joint is the bacteria setting up a place to live on the joint replacement itself.
Interviewer:
What are the signs that this has happened? How can I tell if I just got a surgery that that I’m experiencing an infection?
Dr. Derek Amanatullah:
So the the easiest signs are you’d have a fever, your wound will be red, and your wound might drain after surgery, and you may have pain that’s difficult to control and pain maybe even at rest. The problem with this is that a lot of patients after surgery don’t have an infection have those things you could have pain at rest, some swelling, some redness. And so ultimately it takes a lot of experience to diagnose an infection.
But maybe even more important is what happens if you get infection and it’s not right after surgery. People can get an infection even after surgery either from circulating bacteria in their blood or from that biofilm that got set up on their implants that didn’t show itself was an infection but for years and years and years later. Those patients may feel nothing.They could feel almost no symptoms or maybe just a little bit of vague achy pain.
Or, they can have the things we talked about redness, draining wounds, fevers, chills, and even get sick to the point where they may need to go to the hospital. So infection can present in a very very broad way and it can be sometimes hard to detect.
But if you’re having pain that’s not controlled or something going on with the wound, for sure you need to see someone we need to have a talk about infection.
Interviewer:
If I think I have an infection what should I do?
Dr. Derek Amanatullah:
Very interesting. So I would say, first thing you should do is seek help, see an expert in joint replacement surgery can do some tests to see if you have an infection or not. The most common symptom is pain, and pain can be caused from lots of different things.
If the infection is acute, meaning it’s just started right after surgery we can talk about doing some surgeries to potentially salvage the implant, meaning we can clear out the joint, change the modular parts, and see if we can retain the implant that’s fixed in the ball.
But it’s been going on for a long time in those little bio from cities have set up, we need to talk about removing the implants . So the best thing a patient can do is be vigilant and be aware of the symptoms of infection so they can see their provider to get the best treatment possible.
Interviewer:
So what are those treatments that you referenced?
Dr. Derek Amanatullah:
There are a few. One of them is not antibiotics, again because of those cities. Almost all the treatments for a joint infection are going to be without antibiotics and are going to require surgery.
So if it’s acute meaning it just happened right after surgery we might talk about a second surgery to open up the joint replacement, clean off any of the bacteria that are trying to form those cities, change the implants, and put you on antibiotics. that’s called an “irrigation and debridement and the liner exchange,” change the modular parts.
After that we start talking about other things. Other things might be removing the implant that could be something called the resection, so we actually take the implant all the way out, could mean losing bone, could mean losing a ligament, it could mean lots of things because we have to do additional damage to remove the implants.
And then putting in an antibiotic spacer, or even doing something called a, “one stage exchange,” which means putting in a whole new joint replacement right after we cut out that infection. The short of the story as if you’re on antibiotics it means that we don’t think the fact here on the implant itself but if it’s on the implant, right now, we don’t have a great answer for removing it without some sort of surgery.
Interviewer:
Is there anything the patient can do outside of a treatment from a doctor that would help?
Dr. Derek Amanatullah:
Unfortunately, if there’s really an infection on the implant, chances are no. But the best thing patients can do is be as healthy as possible and to optimize themselves before surgery. Meaning, get your diabetes under control as best as possible, get our weight down as best as we can, have our medicines optimized.
I mean, we really can’t stop from getting a medical problem, per se, but if we have one, we could manage it as best as possible to mitigate the risk at the time of surgery. But for sure, getting infection as a catastrophic side effect of surgery that sometimes happens in some people — it’s a bad complication. The good part is it can be managed in the vast majority of people around ninety percent of the time.
But if the if it happens the knee or the hip is really never gonna be the same, so the best we can do is to avoid it and to be as diligent as possible of looking for it, so that we can get it intervene earlier.
Interviewer:
Got it. Well thank you so much for your time today I really appreciate it!
Dr. Derek Amanatullah:
No problem. Thanks so much
