Infection in Primary Hip and Knee Arthroplasty

Since the advent of prosthetic joint replacement, patients suffering from bone and joint pathology have benefited from significant improvements in mobility and pain relief. In Australia 39,200 hip replacements and 39,500 knee replacements were performed in 2009 (Australian Orthopaedic Association National Joint Replacement Registry [AOA NJRR]) (Graves, et al. 2010). With an ageing population, the number of patients undergoing these procedures is projected to increase significantly over time. Data from the United States of America predicts that by 2030, the number of patients undergoing primary hip and knee replacement will increase by 174% and 673% respectively (Kurtz, et al. 2007). The major complication of such techniques is infection of the prosthetic device, which is associated with significant costs to individual patients and to the public health system. Significant morbidity is associated with prosthetic joint infections including the need for further operative procedures, long-term antibiotic therapy, and prolonged hospitalisation. Thereafter, the mortality rate from prosthetic joint infection is estimated to be between 1.0 to 2.7 precent (Ahnfelt, et al. 1990, Zimmerli 2006, Zimmerli, et al. 2004). Aside from the effects on the individual patient, the financial cost to the health system is considerable. The estimated hospital costs is $ 96 166 (US) per patient requiring revision arthroplasty for infection, which is 4.8 times the cost of a primary arthroplasty(Bozic & Ries 2005). This chapter examines the underlying epidemiology, diagnosis, treatment and challenges in managing this problem.