[Infections in joint prostheses: epidemiology and clinical presentation. A prospective study 1992-1999].

Background: The prosthetic infection is a serious complication due to diagnostic problems.

Aim: To determinate epidemiological characteristics, and clinical patterns of infections associated to prosthetic materials to improve the diagnosis and management.

Patients And Methods: From december 1992 to december 1999, 110 patients with prosthetic infections were prospectively evaluated. Diagnosis was made according to standard microbiological, clinical and radiological criteria.

Results: The incidence was 5.1% (110/1,400) prosthetic materials insert in the period of study. The average age was 59.6 years (range 18-79), and the majority of patients 63 (57.2%) were female. Forty-two (38%) suffered a total knee replacement, 29 (26%) a total hip replacement, 1 (1%) shoulder replacement and 38 (34%) autogenous bone gratting. In 29 patients (26.3%) a previous chronic disease had been diagnosed (diabetes, neoplasis, rheumatoid arthritis). Previous use of antibiotics was detected in 58 patients (51%), being ciprofloxacin the most frequently used. An etiological diagnosis was reached in 66 patients (60%), isolated grampositive in 58.2%, gramnegative in 32.8%, fundamentally by Staphylococcus sp. and P. aeruginosa respectively. In 9% anaerobe were isolated. There were early infections in 67 cases, delayed in 25, and late in 18. All the patients had local pain and flogotiv signs as initial findings, whereas 46 (41.8%) developed osteocutaneous fistula and only 5 (4.5%) presented temperature.

Conclusions: Prosthetic infection is a frequent complication after articular replacement, and grampositive cocci predominate as ethilogical agents. Sistemic clinical manifestations are uncommon.