IV Self-Infusion Training Significantly Reduced Infections After Joint Replacement Surgery

Teaching hemophilia patients who have undergone joint replacement surgery how to administer their intravenous (IV) self-infusions in sterility, can decrease the rate of infections post-surgery significantly, a six-year education program shows.

The program outcomes will be shared at the upcoming World Federation of Hemophilia 2018 World Congress May 20-24 in Glasgow, Scotland.

Hemophilia patients can develop chronic arthritis due to frequent or inadequately treated bleeding into the joints. The symptoms can begin during childhood and, by early adulthood to middle age, hemophilia patients often need joint replacement surgery to improve their quality of life. The joints most frequently involved are the knees, ankles, and elbows.

However, this type of surgery carries a higher risk of bleeding and infection for hemophiliacs when compared to patients with other forms of arthritis.

In the scientific community, many suggested a link between infection following joint replacement in patients with hemophilia to a positive HIV status. HIV induces a state of immunosuppression or dampening of the immune system’s responses.

Researchers at the Orthopaedic Institute for Children (OIC), Los Angeles, California, however, suggested a different source for these high rates of infection.

“Based on our experience and observations, we postulated that the primary risk factor was tied to frequent intravenous (IV) self-infusion,” James Luck, MD, said in a press release. Luck is director of surgery and rehabilitation of OIC’s Hemophilia Treatment Center.

“We wanted to find out the true cause of this and what could be done to mitigate the occurrence of these infections, which usually require removal of the implant, treatment of the infection, and then reinsertion of the implant. If the infection recurs, it will require more procedures and occasionally even amputation,” he added.

In 2005, OIC launched a comprehensive program to teach hemophilic patients who underwent joint replacement surgery on how to safely self-administer their IV injections of hemophilia therapy. From 2005 to 2011, clinicians at OIC performed 49 joint replacements surgeries in a total of 32 patients with hemophilia, who were then taught IV self-infusion.

The results showed that after that, the cases of infection went from 17 percent to an impressive zero percent for these patients. According to the researchers, during this time period none of the patients experienced primary infections.

“While immune suppression might still be an aggravating factor, it is clear from our study that the primary source of late infection in patients with hemophilia is frequent IV self-infusion being poorly administered. Through protocol-driven patient education in sterile techniques for IV self-infusion, the incidents of prosthetic joint infection can be significantly impacted,” said Luck, who also a professor at the UCLA/OIC.