Management and treatment depends on identifying the infection and an appraisal of prosthetic or implant function.
Management of Infection
Culture of the infecting organism is crucial for a rational choice of antimicrobials (antibiotics, antivirals, or antifungals). There are statistical flowsheets that recommend specific antimicrobial regimens for specific prosthetics. Close surveillance, necessary to judge treatment efficacy, is via many of the diagnostic tests done initially: blood tests and cultures, fluid aspiration, lumbar puncture, and imaging studies such as X-rays, ultrasound, CT, and MRI.
Management of Device Failure or Malfunction
Failure of implantables can be subtle initially. Clinicians involved in their insertion and maintenance require a heightened sensibility for even small functional variations. Identification and treatment of infection or overt rejection requires a functional assessment via measurements of the desired outcome of function (homeostasis, as in artificial heart valves) and possibly electronic “interrogation” (as with intrathecal pumps, neurostimulators, or cardiac pacemakers).
Devices that have failed or which are at risk for failure or increase the likelihood of adjacent tissue jeopardy should be removed. If survival is jeopardized without the prosthetic, removal should be accompanied by immediate replacement; if not, definitive (“test of cure”) clearance of the infection should be evident before re-introducing the foreign body.
Considerations for Wearable Prosthetics
The loss of a limb alters the entire dynamic of bodily function, from the altered balance and center-of-gravity from lower extremity loss to repetitive strain injuries from compensating for upper extremity loss. These compensatory changes are multiplied with the use of prosthetic limbs. If fitting for a limb is not perfect, pressure points will indicate the faulty sites where refining the fit is necessary. The friction against the tissues or the pressure ulceration will cause necrosis of exposed tissues that necessitate antibiotic prophylaxis or treatment.