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July 11, 1977

Infection and Total Joint Replacement

Author Affiliations

New York

JAMA. 1977;238(2):129. doi:10.1001/jama.1977.03280020033015

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To the Editor.—  Total joint replacement, particularly of the hip, is rapidly becoming one of the more commonly performed orthopaedic surgical procedures. Deep infection, involving the prosthetic devices and their anchoring acrylic cement, is the greatest threat to the success of these operations.We have observed, from our own experience and the reports of others, that a small but substantial proportion of the late postoperative infections, that is, those becoming apparent several months to several years after surgery, can be attributed to hematogenous seeding of the prosthetic joint from distant primary sources of acute or chronic infection. Broadly speaking, two categories seem to be involved: substantial bacteremia from infections of lung, kidney, skin, and other foci of acute infection, and surgical or dental manipulations, such as abdominal surgery, genitourinary procedures, and periodontal and exodontal surgery.We are taking this means to suggest that all patients who have had total joint