Orthopaedic implant infections: interplay of associated factors


  • Shazia Benazir Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
  • Umar Nazir Department of Preventive and Social Medicine, Government Medical College, Srinagar, J&K, India
  • Shaista Nazir Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
  • Azhar Shafi Department of Microbiology, SKIMS Medical College, Srinagar, J&K, India
  • Lenah Bashir Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
  • Dekyong Angmo Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
  • Asifa Bhat Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, J&K, India




Biofilm, Implant, Infection, Prosthetic


Background: Medical implants are devices that are placed inside or on the surface of the body for functional, cosmetic or therapeutic purposes. Orthopaedic implants are usually associated with infections which lead to devastating complications for the patients. The study was conducted to evaluate the association of various factors considered to affect orthopaedic implant infections.

Methods: The 100 patients with orthopaedic implant infections were included. Various patient parameters including risk factors, intervention form and type of onset of infection were recorded. Microbiological workup was done by standard techniques along with biofilm detection.

Results: Early onset of infection was prevalent in cases with open fractures. Smoking and tissue destruction were the major risk factors. Longer duration of surgery was associated with early onset and polymicrobial infections. 15.5% of the isolates were strong biofilm producers. Staphylococcus aureus was the predominant biofilm producer. More biofilm producing organisms were recovered from stainless steel implants.

Conclusions: Orthopaedic device-related infections lead to extreme morbidity in patients and puts a great encumberance on hospital resources. Various factors affect the outcome of orthopaedic implants. Appropriate infection control and institution specific interventions will help in reducing the magnitude of the problem.


US FDA. Implants and prosthetics, 2018. Available at: https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/. Accessed on 8 January 2019.

Ribeiro M, Monteiro FJ, Ferraz MP. Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. Biomatter. 2012;2(4):176-94.

Fernandes A, Dias M. The Microbiological Profiles of Infected Prosthetic Implants with an Emphasis on the Organisms which Form Biofilms. J Clin Diagn Res. 2013;7(2):219-23.

Barberán J. Management of infections of osteoarticular prosthesis. Clin Microbiol Infect. 2006;12 Suppl 3:93-101.

Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis. 2006;19(4):349-56.

Darouiche RO. Device-associated infections: a macroproblem that starts with microadherence. Clin Infect Dis. 2001;33(9):1567-72.

Mandell G, Bennett J, Dolin R. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone; Elsevier; 2009.

Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466(7):1710-5.

Costerton JW, Montanaro L, Arciola CR. Bacterial communications in implant infections: a target for an intelligence war. Int J Artif Organs. 2007;30:757-6.

Neubauer T, Bayer GS, Wagner M. Open fractures and infection. Acta Chir Orthop Traumatol Cech. 2006;73(5):301-12.

Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC jr. Guidelines for collection, transport, processing, analysis and reporting of cultures from specific specimen sources. In: Colour Atlas and Textbook of Diagnostic Microbiology 6th ed. Lipincott Williams and Wilkins; 2006:68-105.

Christensen GD, Simpson WA, Younger JJ, Baddour LM, Barrett FF, Melton DM, et al. Adherence of coagulase-negative staphylococci to plastic tissue culture plates: a quantitative model for the adherence of staphylococci to medical devices. J Clin Microbiol. 1985;22(6):996-1006.

Stepanović S, Vuković D, Hola V, Di Bonaventura G, Djukić S, Cirković I, et al. Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci. APMIS. 2007;115(8):891-9.

Goel SC. Infection following implant surgery. Indian J Orthopaed. 2006;40(3):133.

Jämsen E, Virta LJ, Hakala M, Kauppi MJ, Malmivaara A, Lehto MUK. The decline in joint replacement surgery in rheumatoid arthritis is associated with a concomitant increase in the intensity of anti-rheumatic therapy: a nationwide register-based study from 1995 through 2010. Acta Orthop. 2013;84(4):331-7.

Zimmerli W, Moser C. Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol. 2012;65(2):158-68.

Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J. Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg Am. 2005;87(3):570-6.

Giulieri SG, Graber P, Ochsner PE, Zimmerli W. Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection. 2004;32(4):222-8.

Khosravi AD, Ahamadi F, Salmanzadeh S, Dashtbozorg A, Montazeri EA. Study of Bacteria Isolated from Orthopedic Implant Infections and their Anitimicrobial Suceptibility Pattern. Res J Microbiol. 2009;4(4):158-163.

Corvec S, Portillo ME, Pasticci BM, Borens O, Trampuz A. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs. 2012 Oct;35(10):923-34.

Laffer R, Graber P, Ochsner P, Zimmerli W. The case for differentiated orthopedic management of prosthetic knee-associated infection. 44th ICAAC: Abstract K-113, Washington, DC. American Society for Microbiology. 2004.

Arruda LRP, Silva MAC, Malerba FG, Fernandes MC, Turíbio FM, Matsumoto MH. Fraturas expostas: Open fractures: prospective and epidemiological study. Acta Ortop Bras. 2009;17(6):326-30.

Jain BK, Banerjee M. Surgical site infections and its risk factors in orthopaedics: A prospective study in teaching hospital of central India. Int J Res Med. 2013;2(1):110-3.

Hirsch T, Spielmann M, Zuhaili B, Koehler T, Fossum M, Steinau HU, et al. Enhanced susceptibility to infections in a diabetic wound healing model. BMC Surg. 2008;8:5.

Durand F, Berthelot P, Cazorla C, Farizon F, Lucht F. Smoking is a risk factor of organ/space surgical site infection in orthopaedic surgery with implant materials. Int Orthop. 2013 Apr;37(4):723-7.

Singh JA, Schleck C, Harmsen WS, Jacob AK, Warner DO, Lewallen DG. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med. 2015 Nov 19;13:283.

Ercole FF, Franco LMC, Macieira TGR, Wenceslau LCC, de Resende HIN, Chianca TCM. Risk of surgical site infection in patients undergoing orthopedic surgery. Rev Lat Am Enfermagem. 2011 Dec;19(6):1362-8.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132.

Moges F, Endris M, Belyhun Y, Worku W. Isolation and characterization of multiple drug resistance bacterial pathogens from waste water in hospital and non-hospital environments, Northwest Ethiopia. BMC Research Notes. 2014 Apr 5;7(1):215.

Arens S, Schlegel U, Printzen G, J Ziegler W, Perren S, Hansis M. Influence of materials for fixation implants on local infection. An experimental study of steel versus titanium DCP in rabbits. J Bone Joint Surgery British. 1996 Jul 1;78:647-51.

Bryers JD. Medical biofilms. Biotechnol Bioeng. 2008 May 1;100(1):1-18.

Clauss M, Graf S, Gersbach S, Hintermann B, Ilchmann T, Knupp M. Material and biofilm load of K wires in toe surgery: titanium versus stainless steel. Clin Orthop Relat Res. 2013 Jul;471(7):2312-7.






Original Research Articles