United KingdomUpdated November 12, 2022 by Jamie
Some questions asked about joint replacement and infections:
Well, there is a lot of confusing information about dental work and infection when you’ve had a joint replacement. There are so many different opinions between the surgeons/dental organisations and in different countries. One says antibiotics 2 days prior and several days after, another says just one dose 1-2 hours prior. Some say forever, another says for the first 2 years. Some people also include other things like colonoscopy, colonoscopic biopsies or polypectomies and even PAP smears while others say those are not a hazard. It's a right royal muddle and no-one seems to have any specific data to back up their own point of view so at the moment that's pretty much all we have to go on - people's points of view.
But truth to tell, most of those who have a late stage infection in their joint replacement have no idea where it came from. Or how many had prophylactic antibiotics that worked or didn't work.
The first thing you need to do is stop thinking of this as a 'normal' or regular kind of infection because it's not.
Almost all medical implants acquire a 'biofilm' which fall under the radar of the body's immune system, due both the inertness of the implant and the biofilm itself.
Biofilm (BF) is a microbial community film created by cells (bacteria) and is attached to a foreign body such as a surgical implant. The organisms have a very unique structure in BF, evolving from a simple single cell structure to a complex structure where organisms communicate in a manner not unlike DNA. This makes them very difficult to eradicate for although various single organisms can be destroyed, the over-all structure of the BF remains and can reproduce. This is the substance that is most problematic when treating these infections.
It has become evident that whilst the basic BF takes a mere 72 hours to mature into this complex structure, removing it is more of a problem. But it has been discovered that in the presence of aggressive chemo-therapy, the BF can be converted to a ‘normal’ structure which can be eradicated.
The biggest problem with BF is in the way it attaches itself to foreign bodies and also in the manner of cell production. Before the BF fully matures, it appears that though antibiotics will succeed in killing off the immature surface cells the ‘persister cells', being invisible to the white blood cells, remain impervious to the drugs.
However, after a period of time, it becomes possible to convert the mature BF into a ‘normal’ substance that can be eradicated. This can take some months and therefore knowledgeable surgeons will not touch new cases until sufficient time has passed for this process to at least be under way. This also allows any cellulitis to have resolved and treatment should not begin until a good period has passed since they last had antibiotics.
Therefore my advice to anyone with this issue is to try and accept that this is going to be a long term condition, much on a par with psoriasis or fibromyalgia. It's going to be part of you for quite some time and you can't keep letting it dog your dreams.
On the plus side, once these bugs colonise an implant and set up a biofilm, they are unlikely to proliferate to a point where they could cause gross infections or even septicaemia. The worst that could happen is that the biofilm will cause implant loosening and maybe a sense of unwellness in the patient. Just don't think it's the end of the world or a harbinger of doom if that does happen.
A surgeon who is taking this subject further than any other I have yet heard about is broken link removed: https://dfwsarcoma.com/about/dr-maale.php.
Some articles of interest regarding antibiotics for dental procedures:
Evidence insufficient to recommend prophylactic antibiotics for dental procedures
Periprosthetic infection: Mayo Clinic study shows that dental procedures are not a risk factor
January 2021 - published report supports not needing antibiotics for dental work following joint replacement
Studies looking at the use of ultrasound to combat the biofilm that can exist on joint implants:
www.ncbi.nlm.nih.gov
www.sciencedirect.com
www.fusfoundation.org
Here are some pertinent articles on the subject:
Periprosthetic Joint Infection (January/February 2013)
Periprosthetic Joint Infection (July 2019)
An Overview of Prosthetic Joint Infection (PJI) Definition and Diagnosis (July 2021)
Some questions asked about joint replacement and infections:
Well, there is a lot of confusing information about dental work and infection when you’ve had a joint replacement. There are so many different opinions between the surgeons/dental organisations and in different countries. One says antibiotics 2 days prior and several days after, another says just one dose 1-2 hours prior. Some say forever, another says for the first 2 years. Some people also include other things like colonoscopy, colonoscopic biopsies or polypectomies and even PAP smears while others say those are not a hazard. It's a right royal muddle and no-one seems to have any specific data to back up their own point of view so at the moment that's pretty much all we have to go on - people's points of view.
But truth to tell, most of those who have a late stage infection in their joint replacement have no idea where it came from. Or how many had prophylactic antibiotics that worked or didn't work.
The first thing you need to do is stop thinking of this as a 'normal' or regular kind of infection because it's not.
Almost all medical implants acquire a 'biofilm' which fall under the radar of the body's immune system, due both the inertness of the implant and the biofilm itself.
Biofilm (BF) is a microbial community film created by cells (bacteria) and is attached to a foreign body such as a surgical implant. The organisms have a very unique structure in BF, evolving from a simple single cell structure to a complex structure where organisms communicate in a manner not unlike DNA. This makes them very difficult to eradicate for although various single organisms can be destroyed, the over-all structure of the BF remains and can reproduce. This is the substance that is most problematic when treating these infections.
It has become evident that whilst the basic BF takes a mere 72 hours to mature into this complex structure, removing it is more of a problem. But it has been discovered that in the presence of aggressive chemo-therapy, the BF can be converted to a ‘normal’ structure which can be eradicated.
The biggest problem with BF is in the way it attaches itself to foreign bodies and also in the manner of cell production. Before the BF fully matures, it appears that though antibiotics will succeed in killing off the immature surface cells the ‘persister cells', being invisible to the white blood cells, remain impervious to the drugs.
However, after a period of time, it becomes possible to convert the mature BF into a ‘normal’ substance that can be eradicated. This can take some months and therefore knowledgeable surgeons will not touch new cases until sufficient time has passed for this process to at least be under way. This also allows any cellulitis to have resolved and treatment should not begin until a good period has passed since they last had antibiotics.
Therefore my advice to anyone with this issue is to try and accept that this is going to be a long term condition, much on a par with psoriasis or fibromyalgia. It's going to be part of you for quite some time and you can't keep letting it dog your dreams.
On the plus side, once these bugs colonise an implant and set up a biofilm, they are unlikely to proliferate to a point where they could cause gross infections or even septicaemia. The worst that could happen is that the biofilm will cause implant loosening and maybe a sense of unwellness in the patient. Just don't think it's the end of the world or a harbinger of doom if that does happen.
A surgeon who is taking this subject further than any other I have yet heard about is broken link removed: https://dfwsarcoma.com/about/dr-maale.php.
Some articles of interest regarding antibiotics for dental procedures:
Evidence insufficient to recommend prophylactic antibiotics for dental procedures
Periprosthetic infection: Mayo Clinic study shows that dental procedures are not a risk factor
January 2021 - published report supports not needing antibiotics for dental work following joint replacement
Studies looking at the use of ultrasound to combat the biofilm that can exist on joint implants:
A Review of the Combination Therapy of Low Frequency Ultrasound with Antibiotics
Single antimicrobial therapy has been unable to resist the global spread of bacterial resistance. Literatures of available in vitro and in vivo studies were reviewed and the results showed that low frequency ultrasound (LFU) has a promising synergistic ...
www.ncbi.nlm.nih.gov
Sonobactericide: An Emerging Treatment Strategy for Bacterial Infections
Ultrasound has been developed as both a diagnostic tool and a potent promoter of beneficial bio-effects for the treatment of chronic bacterial infecti…
www.sciencedirect.com
Infection
Focused Ultrasound Therapy Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients who are infected or who are at risk for infection because of foreign bodies (FB) that are present in their body...
www.fusfoundation.org
Here are some pertinent articles on the subject:
Periprosthetic Joint Infection (January/February 2013)
Periprosthetic Joint Infection (July 2019)
An Overview of Prosthetic Joint Infection (PJI) Definition and Diagnosis (July 2021)
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