Mr. Duong, 68 years old, had a hip replacement 14 years ago, had repeated infections causing pain and fluid leakage, and had to have his artificial joint replaced again.
Over the past 14 years, Mr. Duong has had surgery three times to remove infected lesions, still keeping the artificial joint, but the pain, fever, fluid leakage persisted, and his physical condition was not completely cured. Recently, the infection spread and became severe, so he went to Tam Anh General Hospital in Hanoi for treatment. Results of X-rays, blood tests, and joint fluid aspiration showed that the bone was punctured, white blood cells were increased, and hemolytic Staphylococcus aureus bacteria were present in the damaged joint area.
On November 1, MSc. Nguyen Quang Ton Quyen, Deputy Head of the Department of Trauma and Orthopedics, Tam Anh General Hospital in Hanoi, said the patient had re-infection after hip replacement. If the inflammation is only localized in the external area, the patient may only need intravenous or oral antibiotics; more severe cases only require rinsing, without removing the prosthetic joint. Mr. Duong suffered repeated inflammation, the infection spread, the surgical wound oozed fluid, bone loss around the acetabulum, the upper end of the femur, and even spread into the pelvis and iliopsoas muscle. The only way was to remove the joint. If not intervened immediately, the patient is at risk of further bone loss and loss of mobility.
Mr. Duong suffered from kidney failure, compensated cirrhosis, and the infection climbed to create a large abscess in his back. Surgical treatment of infection is quite complicated, there is a lot of blood loss, the patient’s weak condition slows the recovery speed, and the risk of complications is high, the most common being myocardial infarction. To rule out the cause of health deterioration due to tuberculosis infection, the doctor prescribes a TB culture for monitoring while the patient recuperates. TB results were negative. After a month of intensive care, the patient recovered enough to have surgery.
The patient was put under anesthesia by medical staff and prepared for surgery. Image: Tam Anh General Hospital
Mr. Duong was prescribed a two-stage prosthetic joint replacement. In phase one, the doctor removes the prosthetic joint, dredges out all inflammatory tissue, injects antibiotics to suppress infection and maintains oral antibiotics.
After 7 weeks, his condition stabilized, he entered the second step of having a joint replacement to restore movement. Due to the widespread infection, doctor Quyen chose a new artificial hip joint with a long shank, adjusted based on the actual level of bone loss, ensuring maximum restoration of range of motion for the patient. After two surgeries, Mr. Duong is now healthy, mentally comfortable, and has begun to exercise.
According to Dr. Quyen, hip replacement is an advanced surgical treatment method that helps restore range of motion to the joint in cases of degenerative joint deformity and necrosis of the femoral head. However, there are still some postoperative complications, about less than 2% of patients experience serious complications, typically hip infection.
There are many causes of infection after hip replacement, one of which is an unhygienic surgical environment. Artificial materials used for joint replacement create conditions for bacteria to have places to adhere and develop biological barriers, helping them hide and avoid the body’s immune system. Infection caused by bacterial invasion can occur in the skin, soft tissues around the joint or spread deep into the artificial joint. Patients can get infections during their hospital stay, after discharge, or many years after surgery.
Treatment of infection after joint replacement is much more complicated and expensive than joint replacement. Doctors recommend that patients with artificial joint replacement who experience sudden joint pain, red skin around the incision, high fever, night sweats, fatigue… should see a doctor after 2-3 weeks.