Center for the Treatment of Bone and Joint Infections

At the USC University Hospital Center for the Treatment of Bone and Joint Infections, world experts in the fields of orthopaedic surgery, infectious disease and plastic surgery provide a comprehensive program of management in one centralized location.

The Center's multidisciplinary team, faculty of the Keck School of Medicine, is recognized for its clinical expertise in the treatment of osteomyelitis, infected non-unions of bones, infected total joints, bone reconstruction and muscle and microvascular soft tissue transfers.

This team is led by Michael J. Patzakis, M.D., who specializes in the treatment of orthopaedic infections, and Paul D. Holtom, M.D., an infectious disease specialist.

Advanced Expertise in a University Setting

Because the USC University Hospital Center for the Treatment of Bone and Joint Infections is located in a university setting, team members are actively involved in academic and research activities. This involvement allows them to bring the latest advances in research to the clinical setting, much to the benefit of their patients.For example, Center members have participated in an FDA-approved five-center project studying the use of antibiotic-impregnated beads in the treatment of chronic osteomyelitis. The chain of antibiotic beads is surgically placed wwithin the area of the infected bone or joint, allowing the antibiotic to elute out into the surrounding tissues. As a result of this successful research, patients who could benefit from this delivery system have direct access to this antibiotic therapy at the Center.

Orthopaedic Infections - A Complex Condition

Orthopaedic Infections occur in approximately one percent of all orthopaedic operations. While this figure may appear small, the large numbers of these surgeries performed nationwide result in thousands of bone and joint infections annually.

The complexity of orthopaedic infections requires a comprehensive treatment approach that involves infection control, antibiotic therapy, surgery and reconstruction, and may require soft tissue transfer and bone grafting.

Bone and joint infections result from three conditions: trauma, direct inoculation following surgery, hematogenous (blood-borne) spread or spread from a nearby infection. Diabetics are also prone to infection because of microvascular problems and lack of sensation in the extremities.

Trauma

Orthopaedic infections may occur following fractures, especially open fractures. Treatment of infected fractures first involves controlling the infection through antibiotics and surgical debridement (the removal of contaminated tissue or material to prevent infection). Stabilization of the fracture is essential. A large number of these cases require soft tissue transfers to provide adequate coverage over the bone. Autogenous bone grafts may then be necessary to fill in a bone defect and/or to heal the fracture.

Plastic surgeons perform either local muscle transfer or free vascular muscle transfer using microvascular techniques.

Infections Following Surgery

• Internal fixation with metal
  Infections may also occur from fractures treated with open reduction and internal fixation techniques using metal rods, plates, screws and/or pins. In most cases, it is necessary to remove the metal during surgical debridement and to stabilize the fracture using such means as an external fixator. Antibiotic therapy is important in treating these infections. Muscle coverage and/or bone grafting may be required.
  
• Total joint replacement
  Approximately one percent of all total joint replacements become infected. Some infections occur immediately following surgery. In the chronic or late infections, it is usually necessary to remove the prosthesis in order to control or eradicate the infection. Following infection control, patients may be evaluated by the Center's team to determine the possibility of prosthesis reimplantation.

Hematogenous Infections

Hematogenous orthopaedic infections usually occur from a secondary source of infection such as urinary tract infections and soft tissue abscesses. The bacteria are carried through the blood stream and invade the bone or joint. These infections are not only limb-threatening, but life-threatening as well.

Hematogenous infections require antibiotic therapy and surgical management. If osteomyelitis is present, a "window" is surgically made in the affected area, allowing the abscess to drain. A bone graft may be necessary if a large amount of dead bone is removed. Joint infections also require incision and drainage.

Highly Individualized Antibiotic Therapy

Aggressive antibiotic therapy plays a key role in eradicating and controlling orthopaedic infections. This therapy is highly specialized because of the variability involved in bone infections and the large number of antibiotics from which to choose. The USC University Hospital Center for the Treatment of Bone and Joint Infections offers great expertise in this area, providing highly individualized care that is monitored on a day-to-day basis.

Antibiotic therapy is best determined by culturing the infected area to ascertain if the infection is caused by a single organism or multiple organisms. Next, the Center specialist selects the antibiotics, or combination of antibiotics, that would most likely succeed in eradicating or controlling the infection for each individual patient.

In making this determination, the patient's health condition, prior exposure to antibiotics, antibiotic allergies and tolerance, and orther vital factors are taken into consideration. Patients are then monitored regularly for drug tolerance and to assess the effectiveness of the therapy.

Reconstructive Microvascular Surgery

Successful complex wound management is crucial to patients with orthopaedic infections. The addition of healthy vascularized soft tissue obliteration of dead space, and closure of wounds without tension plays a central role in our high cure rates. A large experience in myocutaneous flap and microvascular surgery allows us to offer this expertise as part of our armamentarium in the comprehensive treatment of these devastating injuries. Each patient is reviewed by the Center's faculty to determine their indications for soft tissue coverage.