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A Tale of Two Elderly Joint Replacement Experiences

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Nice piece on the New York Times’ “New Old Age Blog” about old patients getting new joints.

The piece includes messages about shared decision-making and the importance of understanding both potential harms and benefits; about realistic expectations that joint replacement is not a fountain of youth; and about “a caution about so-called minimally invasive joint replacement surgery: the American Academy warns that there’s insufficient evidence that this approach, the subject of much media attention, produces quicker recoveries or better results.”

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Greg Pawelski

May 24, 2010 at 4:04 pm

Thanks for pointing out the article Gary. However, it didn’t even broach the subject of orthopedic device-related infections (ODRIs). Both my parents, recipients of knee replacements in their eighties, had to undergo the debilitating effects of post-surgical infections.
Because the percentage of patients aged >65 years is on the rise, the number of patients requiring implants continues to grow, as will the risk for ODRIs. In the United States, 4.4 million people have at least 1 internal fixation device and 1.3 million have an artifical joint.
Sophisticated prevention strategies have been developed during the past two decades to lover the risk of infectious complications in implant surgery. Although the incidence of ODRIs is low, even a low risk of infection can result in a number of patients with ODRIs. And the treatment of such an infection is poorly standardized.
Seven years ago, my mother experienced Biofilm formation to her knee device in her right leg. All implants undergo physiological changes after implantation. The earliest and probably clinically most important step is the “race for the surface,” a contest between tissue cell integration and bacterial adhesion to that same surface.
On contact, body fluids immediately coat all surfaces with a layer of host material, primarily serum proteins and platelets. Adherence progresses to aggregation of microorganisms on the surface of the foreign body, forming a Biofilm. Hers happen to be the deadly pseudomonas aeruginosa.
She had to have her device removed, debridgement, surrounding tissue cured of infection, and then a second prosthetic device implanted five months later. My father was luckier. He went right to antibiotic treatment, for the rest of his life, after an aspiration culture identified the bacterium. His life, however, circumbed to drug-induced pancreatitis, three years later.
My mother is presently fighting another ODRI at 95 years of age. We are hoping to just antibiotic treatment with implant retention will be successful.