Total joint replacement surgery is one of the most cost-effective and widely used interventions in medicine, according to the National Institute of Health. There are more than 1 million of these procedures performed in the United States annually and this number is expected to increase to nearly 4 million by 2030.
For all this success, a small percentage of these procedures, about 10,000 patients, develop infections. To reduce this infection risk, Dr. Terry Clyburn, who is an orthopedic surgeon, created small antibiotic beads that are about the size of grains of salt, designed to release antibiotics at a level high enough to kill infections for at least three to six weeks — the timeframe when an infection is most likely to develop.
In his research, he noted, “There is a risk of infection with any surgery, but infections after a joint replacement surgery are harder to treat. The metal implants are not connected to the body’s bloodstream, so the white blood cells sent to fight the infection cannot reach the implant and kill the bacteria.”
Joint Replacement Surgeons – Impeccable Attention to Detail
As a total joint surgeon and a member of the Texas Health Spine & Orthopedic Center referral line , Dr. Kwame Ennin has a well-earned reputation for having minimal infections among his joint replacement patients.
“As a group, joint replacement surgeons have impeccable attention to detail,” Dr. Ennin said. “That’s the first line of defense as it relates to sepsis. This condition involves the presence of harmful bacteria and their toxins in tissues, typically through infection of a wound.
“The percentage of infections from joint replacement surgery is very small. It ranges from less than one percent to three percent of these procedures. So, the risk is low but, nonetheless, it is real.”
The Proper Use of Antibiotics
“Antibiotics are a useful tool in the fight against infection,” Dr. Ennin said. “At the same time, it is important to be judicious in their application because antibiotic resistance can complicate recovery.
“The developers of this antibiotic bead treatment are currently awaiting FDA approval and they expect to receive this in 3 to 8 years. However, as far as treating sepsis that already exists, I certainly use antibiotics to treat them.
“Most joint replacement patients will be given intravenous antibiotics before and after their surgery to help stave off an infection. By coating the implant in the antibiotic microspheres before placing it in the patient’s joint, the antibiotics are delivered directly to the surgical site to help prevent bacteria from developing into an infection.”
Additional Treatments to Avoid Infections
“There are several things that we use to reduce the risk of infection,” Dr. Ennin said. “For example, we use adhesive film on the patient’s skin during surgery to minimize their ability to shed hair, which can carry germs. We also shave patients before surgery for the same reason.
“Additionally, we administer antibiotics before, during and after the operation. Plus, we irrigate the wound copiously during the surgery. So, you can see we do many things in order to minimize these risks.
“The utility of these antibiotic beads, once they are approved, is that they will allow high concentrations of antibiotics within the tissue that is being treated. Over time, as the beads are continued to be distributed this effectiveness continues. This will be a very useful tool for dealing with infections.”
Is There Something About an Artificial Joint That Can Cause Infection?
“There is nothing in the composition of the prosthesis that can lead to an infection. However, artificial implants allow the infection to thrive in ways that they would not do with living tissue.
“When a patient presents with an infection, the usual treatment is surgical. The reason for this surgical approach is because bacteria are particularly adept at ‘hiding’ from treatment around foreign material such as a replacement joint.
“They form what is called a “bio cell,” which is the molecular equivalent of a plastic wrap that you would use to wrap food that’s going in the fridge. This bio cell material protects the bacteria from the antibiotics that are trying to kill it. Instead, it thrives. This situation requires an effective, surgical removal of the infected material.”
Talk to Your Surgeon
“If a patient is considering a joint replacement, I recommend they discuss this potential for infection with their surgeon before the procedure. Asking about the percentage of infections they have had and the methods they use to prevent these is valuable information. If the surgeon does not seem to have the correct approach, seeking a second opinion is always advisable.”
Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.