Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics

Abstract

Prosthetic joint infections (PJI) represent one of the major problems in orthopedic prosthetic surgery. The incidence of PJIs varies according to the site of intervention, and different published case studies report occurrence at 0.5 to 3.0% in the event of first implants, with a significant greater risk in the case of prosthesis revisions. The diagnosis of prosthetic infections is seldom simple, needing a multi-specialist approach, which includes the accurate collection of patient anamnesis, its clinical evaluation, the evaluation of inflammation biomarkers, and the use of imaging techniques. It is essential to identify the bacteria responsible for the infection not only for an accurate diagnosis, but also to select the correct antibiotic treatment. Failure to identify the bacteria involved makes it impossible to establish targeted systemic antibiotic therapy. In developed countries such as Italy, the right to health is guaranteed by the Constitution, where the institutions that provide health services must be staffed by a team of medical professionals that can guarantee the safest possible health pathways. Risk management represents the set of actions aimed at improving the quality of the care provided, the adherence to guidelines and good care practices with the final objective of guaranteeing patients’ safety. All hospitals, including the ones where prosthetic orthopedic surgery is performed, must adopt clinical risk management procedures which, through prospective tools aimed at preventing errors and complications and by retrospective methods, permit the identification of critical points in the different phases of the process and propose actions for improvement. The constant increase in litigation for malpractice in Western countries, especially in Italy, calls for special attention to the problem of PJIs and the in-depth assessment of medico-legal problems, also considering the new legislative initiatives in the field of medical malpractice. Hospitals need to tackle the onset of PJIs in a transparent and linear fashion by constantly informing the patient on their progress.

Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials

“…Again, it depends on the surgical skill of the surgeon to keep the operation time as short as possible in minimally invasive THA, since excessive operation times of more than 180 min. after joint replacement are associated with significant blood loss (more than 800 mL), blood transfusion, excessive tissue trauma, the presence of nosocomial bacterial strains, and failure to follow the rules of asepsis and antisepsis [ 81 ].…”

Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry

“…In particular septic failures are more likely [ 26 ]. Patient-specific factors are thereby in a complex interaction with surgical specifications, as the implant and technique, and are thus involved in the development of an infection [ 27 ]. Oltean-Dan et al therefore reported a particularly higher risk of FNF patients developing PJI [ 28 ].…”

Factors associated with postoperative quality of life in patients with intertrochanteric fracture

“…We found a positive correlation between WBC before surgery and SF scores for PF, BP, GH and PCS. The immune response being known in order to limit infection might influence functional outcomes 36 . The number of platelets also correlated with better BP and vitality scores.…”