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Prevention and Optimal Treatment of Infected Total Joint Arthroplasty

Charles M. Davis, III, M.D., Ph.D.

Charles M. Davis, III, M.D., Ph.D.

Infection of a total arthroplasty is a serious complication that typically requires complex treatment of the infection and frequently revision surgery. Charles Davis, III, M.D, Ph.D., Penn State Hershey Bone and Joint Institute, says, “Infection is highly suspected in any patient with a recent total joint arthroplasty, when the site continues to drain for more than seven days post-operatively, as well as in a patient with a long-standing arthroplasty that shows a pattern of recurrent drainage, or with a sudden onset of severe joint pain, swelling, redness, and heat.” As the chief of hip and knee joint arthroplasty, Davis sees many suspected cases of total joint arthroplasty infections. “Management of patients with infections is difficult for both the physician and the patient. Treating the infection, placement of a new device, and postoperative recovery may take six to twelve months.”

The heavy disease burden of this problem has led Davis and his team to launch an aggressive protocol aimed at prevention. An infectious disease specialist, Crystal Zalonis, D.O., has been central in planning and implementing all preventive and infection treatment efforts. We focus on preoperative, intraoperative, and postoperative measures to prevent infection. Perioperative preventive steps focus on optimizing blood glucose levels and reducing bacterial carriage. “One key to minimizing infection risk is maintaining tight blood glucose control. In diabetic patients, if preoperative hemoglobin A1c (HbA1c) is more than seven, we defer surgery for a time, until better glucose control is achieved. In the acute postoperative period, blood glucose levels are monitored for all total arthroplasty patients, diabetic and non-diabetic alike. Blood glucose levels are carefully managed for all patients after surgery,” explains Davis. Continue reading

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