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My brother lives in Texas and I live in Illinois. We both had knee replacements at about the same time. We both got infections in the joint (yes, about the same time). The only difference is that he was treated with cleaning the joint out and could keep his implant. I had to have part of mine removed and replaced. Is this a difference in the actual problem or because we live in different states? I don't know what to think, but I do wonder about it. Maybe I should have gone there for treatment.

There's no doubt that treatment for infection after joint replacement can vary. But it's not necessarily because of where you live (though that can be a factor). Joint and implant infection after joint replacement is a complex and challenging problem to solve for a number of reasons. First of all, general health and nutrition are very, very important in preventing infections or in the case of infections that do develop, in getting better. A healthy adult who is not overweight and does not have other problems has a better chance of recovery with less invasive treatment. Second, older adults are living longer with more comorbidities. Comorbidities refer to other diseases and illnesses present at the time of the joint replacement surgery. For example, high blood pressure, heart disease, obesity, diabetes, cancer, thyroid problems, gout, and arthritis are just a few of the more common problems seniors have -- and most patients facing joint replacement have many health conditions referred to as multiple comorbidities. Third, it's no secret that bacteria have become "superbugs" now. This means they are able to resist antibiotics previously used to kill them. They actually change their own structure and genetic code to shield themselves from the effects of antibiotics. So depending on the type of infection you both had, you may experience different treatment and different results. And finally, infections that develop later or that are not treated early can become chronic. These types of infections are even more difficult to stop. Even with treatment to clean out the joint, remove, and replace the implant, these bacteria linger and can resurface when the second surgery is done. Bacteria that enter the blood stream can also travel throughout the body, sometimes even causing death from a condition known as septicemia. The fact is, infection after joint replacement is possible, affects up to two per cent of patients receiving their first implant, and costs four times the price of the replacement surgery. Surgeons are working hard to gather data and information that might help first with infection prevention and second with treatment. Forty years of research has shown that cleaning the joint (a procedure called irrigation and debridement) isn't always enough. Current clinical guidelines based on evidence gathered over time recommend irrigation and debridement alone (preserving the original implant) only for certain patients. These select individuals 1) are in good health with good nutrition and good immune system function, 2) do NOT have the type of bacteria that are antibiotic resistant, 3) DO have an acute infection (early on after surgery) that is diagnosed quickly, and 4) are able to follow their physician's advice about taking antibiotic therapy as directed. Your brother likely met all of this criteria. Only those patients who meet the criteria just described should be selected for this more conservative care. There is plenty of evidence that irrigation and debridement alone will result in poor results and a poor prognosis with a high rate of implant failure. It sounds like you both received the best, most appropriate treatment for your individual differences -- and that's what is important!

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