Managing Chronic Osteomyelitis in Elderly Patients with Joint Replacements

Please consult a physician in Kaohsiung who specializes in the treatment of osteomyelitis?

Hello, Director.
My father is 78 years old.
About two years ago, he experienced pain and acute inflammation due to wear and tear from a long-term artificial joint.
He underwent debridement and had a temporary artificial joint placed.
In July of last year, he had a new artificial hip joint installed (he had inflammation, and the doctor initially planned to use bone cement and antibiotics, but during the surgery, tests showed low inflammation markers.
Considering my father's age and his dialysis treatment, the decision was made to proceed directly with the new artificial joint).
However, he has continued to experience inflammation post-surgery, so the operating physician prescribed antibiotics for several months.
Later, the doctor said my father's condition was stable and suggested no further follow-up was necessary.

Nonetheless, he continues to have bone pain, which fluctuates in intensity.
We took him to another hospital for a nuclear medicine scan, and the doctor diagnosed him with chronic osteomyelitis.
After two weeks of antibiotics, his inflammation markers dropped to around 16, so the doctor recommended continuing the antibiotics, and he has been on them for another two weeks.
However, in recent days, his bone pain has worsened again.
This two-year ordeal has been very taxing for my father.

I would like to ask you, Director, whether it would be advisable for the doctor to surgically remove the artificial joint and treat him with antibiotics? Additionally, after surgery, what is the likelihood of recurrent osteomyelitis when a new artificial joint is placed? If the risk is high, then surgery may not be the best option.
I see how exhausted and distressed he is.
Thank you, Doctor.

A-Rong, 40~49 year old female. Ask Date: 2017/04/09

Dr. Chen Yongxue reply Orthopedics

Once an artificial joint becomes infected, it turns into a nightmare.
Debridement surgery, along with intravenous or oral antibiotics, may only help to control the infection but not cure it.
To achieve a cure, the artificial joint should be removed, and antibiotic-impregnated bone cement should be used to maintain the position of the bone.
After a period of time, once the infection is under control, a new artificial joint can be implanted.
However, even with this extensive procedure, the risk of reinfection still exists.

Reply Date: 2017/04/09

More Info

Managing chronic osteomyelitis in elderly patients, especially those with joint replacements, is a complex and challenging issue. Your father's case illustrates the difficulties that can arise after joint replacement surgery, particularly in older patients who may have underlying health conditions, such as kidney disease, which can complicate treatment options.

Chronic osteomyelitis is an infection of the bone that can occur after surgical procedures, including joint replacements. In elderly patients, the risk of infection is heightened due to factors such as decreased immune response, comorbidities, and the potential for poor wound healing. In your father's situation, the history of pain and inflammation following the installation of a new artificial hip joint suggests that there may be an ongoing infection or inflammatory process that needs to be addressed.

1. Surgical Intervention: The decision to remove the artificial joint and treat the infection with antibiotics is a significant one. If the infection is localized and the surrounding bone is not severely compromised, the removal of the prosthesis may be warranted. This procedure, often referred to as a two-stage revision, involves removing the infected joint, treating the infection with antibiotics, and then, after a period of healing, placing a new joint. The advantage of this approach is that it allows for the infection to be adequately treated before re-implantation, which can reduce the risk of recurrence.

2. Risk of Recurrence: The risk of osteomyelitis recurring after re-implantation of a new joint can be significant, particularly in patients with a history of chronic infections. Factors that can contribute to this risk include the presence of biofilm-forming bacteria, the patient's overall health, and the effectiveness of the initial treatment. In cases where the infection is not fully resolved before the new joint is placed, the likelihood of recurrence increases.

3. Antibiotic Treatment: Continuing antibiotic therapy is essential in managing chronic osteomyelitis. The duration of treatment can vary based on the severity of the infection and the patient's response to therapy. Regular follow-up with blood tests to monitor inflammatory markers is crucial to assess the effectiveness of the treatment.

4. Quality of Life Considerations: It's important to consider your father's quality of life when making treatment decisions. Chronic pain and recurrent infections can significantly impact his overall well-being. Engaging in discussions with his healthcare team about pain management strategies, rehabilitation options, and the potential benefits and risks of surgical intervention is vital.

5. Multidisciplinary Approach: A multidisciplinary approach involving orthopedic surgeons, infectious disease specialists, and pain management experts can provide a comprehensive treatment plan tailored to your father's needs. This team can help weigh the risks and benefits of surgical intervention against the potential for improved quality of life.

In conclusion, while surgical intervention may be necessary to address the chronic osteomyelitis, it is essential to carefully evaluate the risks involved, particularly in an elderly patient with multiple health concerns. Open communication with your father's healthcare providers will be key in navigating this challenging situation and ensuring that he receives the best possible care tailored to his specific circumstances.

Similar Q&A

Preventing Osteomyelitis: Key Insights for Rheumatoid Arthritis Patients

Hello, Doctor! I am a 42-year-old patient with rheumatoid arthritis. Since the onset of my condition, my inflammatory markers (ESR) have consistently been above 9, which is quite high. As a result, I have undergone total knee and hip replacements. Unfortunately, on January 7 of t...

Dr. Shi Guozheng reply Orthopedics
The transmission route is usually through the bloodstream and is related to immunosuppressive medications. There is a possibility of recurrence. If there are implants or artificial joints in the body, antibiotics may be less effective in reaching the site. Prevention involves mai...

Joint Replacement Surgery: Considerations for Diabetic and Elderly Patients

My father-in-law has had degenerative arthritis for several years and underwent a successful total knee arthroplasty over a decade ago. Now at 70 years old, he also has diabetes and has developed foot deformities due to gout. Recently, the family is considering having him undergo...

Dr. Hong Ximing reply Orthopedics
Hello peko922, if a diabetes patient has stable blood sugar control, wound healing should not be an issue, and the success rate of surgery for a 70-year-old is generally high. If joint degeneration has reached the point where joint replacement is necessary, it is best to assess t...

Managing Chronic Osteomyelitis and Open Wounds: A Patient's Guide

Hello, Doctor. My father is 58 years old and has a history of high uric acid and gout. Several years ago, he underwent a procedure to remove bone screws from his calf, which left a wound approximately 1.5 cm in diameter (deep enough to expose bone) that has not healed. Initially,...

Dr. Shi Guozheng reply Orthopedics
If osteomyelitis is confirmed, surgical intervention to remove necrotic bone and perform bone grafting may improve the condition. Additionally, hyperbaric oxygen therapy has been used for treatment, and antibiotic therapy is also necessary.

Managing Osteomyelitis After Knee Replacement: Risks and Solutions

Hello Dr. Lin! I underwent a knee replacement surgery on April 3rd last year, which led to an infection and osteomyelitis: ESR 70; CRP 5.35. I was hospitalized for treatment for six weeks in November last year, and upon discharge, my ESR was 33; CRP 1.68. After discharge, I retur...

Dr. Lin Gengxiao reply Orthopedics
1. The condition referred to as periostitis in the letter is likely a miscommunication; it should refer to a wound with prolonged poor healing accompanied by inflammation. 2. Due to the lack of detailed clinical information, it is difficult to determine the condition; however, ba...