Orthopedic Implants and Antibiotic Applications

Antibiotic Bead Chain Implants

• Antibiotics are applied to bone cement and covered with an artificial skin graft to achieve high local dosages, creating a sterile wound.

Removal of Implant or Prosthesis

• Removing an implant or prosthesis is an option to treat infection.

Treatment Options

• Antibiotics can be administered through irrigation or a PICC line for strong antibiotics.
• Hyperbaric O2 chamber increases oxygen to tissue.
• Amputation may be necessary if infection does not respond to antibiotics.

Nursing Care

• Sterile dressings with normal saline are used, and wet-to-dry dressings are applied.
• Heat application and exercise are avoided to prevent spreading the infection.
• Good body alignment and frequent position changes are important.
• Psychologic support is necessary as wound healing may take a long time.

Prevention

• Prophylactic antibiotics are given to patients with implanted prosthetic devices before invasive procedures, including dental work.

Complications

• Pathologic fractures and deformity can occur.

Amputation

Terms and Types

• Stump: the remaining portion of the amputated limb.
• BKA (Below the Knee Amputation): amputation of the leg below the knee.
• AKA (Above the Knee Amputation): amputation of the leg above the knee.

Indications for Amputation

• Poor blood circulation (PVD)
• Gangrene
• Traumatic or thermal injury
• Malignant tumors
• Uncontrolled, widespread infection
• Congenital disorders

Diagnostic Studies

• WBC count
• Arteriography
• Doppler (to assess circulation and detect tumors, injuries, etc.)

Nursing Care for Amputation

• Assess preexisting illnesses
• Preop teaching: explain reasons for surgery, postop expectations, phantom pain, and rehabilitation
• Postop care: vital signs, dressings, sterile technique
• Rehabilitation: safety, compression bandage, transfers, crutch walking, and prosthesis fitting

Complications of Amputation

• Hemorrhage
• Infection
• Amputation contractures