Hematogenous Infection in Total Joint Replacement

Abstract

TOTAL joint replacement has been accepted as effective treatment for painful arthritis by the medical community. Indeed, between 1972 and 1976, an estimated 0.5 million joint prostheses were implanted in the United States.¹Infection of a prosthesis is one of the most serious complications of total joint replacement and is associated with serious morbidity and mortality.^2,3The pathogenesis of this infection, including portals of bacterial entry, is currently under debate, but evidence is accumulating to suggest that organisms are introduced by two routes: first, by local contamination at the time of surgery,⁴and later, by the hematogenous route.^5-7Prophylactic antibiotics and local wound care precautions can substantially reduce the incidence of early infections, but appear to have little effect on late sepsis.⁸We report here a case of<i>Staphylococcus aureus</i>hip sepsis occurring five years after total hip replacement, in association with an infected ulcer