Late deep wound infection secondary to hematogenous spread of bacteria
from a distant focus is an infrequent but devastating complication of total
joint replacement. Nine patients (ten implants) with documented late
hematogenous infection are reported, all of whom demonstrated several
characteristic features. The initial operation was free of clinical
evidence of infection and a long asymptomatic interval ensued, followed by
a definite febrile illness and acute joint pain. The source of the
infection often was not recognized until late and prophylactic antibiotics
were not given when it was identified. Seven of the ten implants had to be
removed. The primary responsibility for the prevention of this devastating
complication lies with the surgeon, who must inform each patient of the
risk of late hematogenous seeding from infection elsewhere in the body. It
is also important to pay special attention to patients who are at
particularly high risk, such as those with rheumatoid arthritis or other
systemic diseases. A knowledge of the bacterial flora of the various areas
of the human body is essential in choosing the appropriate prophylactic
antibiotic.