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With all we know now about "superbugs", what is being done to find better ways of treating joint infections after joint replacement? My mother is having hip replacement surgery next week. I'm the family nurse (professionally and personally) and I need to get up-to-date on this as I normally don't work in orthopedics.

As a natural consequence of rising numbers of total hip and total knee joint replacements there has been an increase in the number of postoperative infections. As a nurse, you know this complication can have devastating results. And it 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, as you mentioned, 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. 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. Forty years of research has shown that cleaning the joint (a procedure you may know as 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. Research is ongoing trying to sort out the best approach to the problem of infection after joint replacement. Best antibiotic to use, length of time to use it, and method of delivery remain under investigation. Some surgeons are trying direct infusion of antibiotics into the joint for six weeks. This treatment approach is called intraarticular infusion. Others are trying repeated irrigation and debridement procedures either alone or in combination with removal and replacement of the infected implant parts. As always, the best offense is a good defense. There isn't much you can do to prevent iatrogenicinfection (caused by hospitalization). Surgical and hospital staff must work to prevent infections. But you can exert some influence by practicing (and teaching your mother and all visitors to practice) good handwashing. A healthy diet for her before and after surgery can also help. As a nurse, quickly recognizing any signs of infection and notifying her surgeon or primary care physician will go a long way in early treatment with better results.

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