Case Reports: Periprosthetic Joint Infection after Total Joint Arthroplasty Following Swimming Activity

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

Introduction: Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty (TJA), occurring in approximately 1–2% of primary procedures. These infections, characterized by an overall weighted mean incidence of 0.97% for total hip arthroplasty (THA) and 1.03% for total knee arthroplasty (TKA), pose significant challenges for patients and health-care providers. Case Report: The authors present two intriguing case reports. The first involves a 64-year-old male who underwent TKA 17 months prior and presented to our outpatient clinic with clinical symptoms and laboratory findings consistent with PJI. Subsequent Streptococcus dysgalactiae culture results confirmed the diagnosis. The second case involves a 51-year-old male who presented to our outpatient clinic 2 weeks after undergoing THA, with clinical symptoms consistent with infected hematoma, which was later confirmed with positive Staphylococcus lugdunensis culture results and another infected process, occurring 3 months after the initial procedure, confirmed by positive Group B Streptococcus (Streptococcus agalactiae). Both patients reported swimming in a recreational swimming pool before and after the procedures and during the follow-up period, approximately 2–3 times a week. Those patients reported resuming their recreational swimming activities just a few days after the procedures. Although as part of post-operative wound care, we instruct all of our patients not to get the wound wet for the 1st days after surgery, to our knowledge swimming activities are not included in the various risk factors for developing a PJI, nor are the bacteria mentioned above associated with aquagenic infection. Conclusion: Although swimming activity has not been identified as a known risk factor for PJI, it is important for physicians to maintain a high clinical suspicion for delayed or late infections in patients who engage in swimming activities. Further investigations are warranted to determine the potential role of recreational swimming activities as a risk factor for PJI after TJA. Keywords: Periprosthetic joint infection, total knee arthroplasty, total hip arthroplasty, total joint arthroplasty, swimming activity, peri-prosthetic joint infection