Abstract
Purpose: We report results of management of infected total knee arthroplasty (TKA). Our aim was to analyse the different therapeutic options and identify factors predictive of cure.
Material and methods: This retrospective multicentric analysis included a consecutive series of 179 cases of infected TKA. Revision TKA was performed for 77 knees in two operative times, 30 in one operative time. Synovecetomy was performed for 26 knees, arthrodesis for 36 and amputation for nine. Minimum follow-up was two years. For each case, we assessed cure of infection and functional outcome. Non-parametric statistical tests were used to compare outcome.
Results: Mean follow-up was 41.2 months. There was a 17% death rate during the first two years after management of infected TKA. Cure was achieved in two-thirds of the revised cases (in one or two operative times) and in 54% of the synovectomy cases. Arthrodesis yielded cure in 50%. Staphylococci was identified in 65%. The functional outcomes of revised prostheses (two times) was less satisfactory if the anterior tibial tubercle was removed, if the extensor system was involved, or if a flap cover was necessary (p< 0.05). There was no significant difference in functional outcome for one-time and two-time operations. Cure was achieved in 95% of the synovectomies performed before 16 days. Relapse occurred in 95% of those performed after 56 days. Arthrodesis performed in patients with major bone loss failed. Among the arthrodesis failures, 50% were related to mechanical failure and the other 50% to recurrent infection.
Discussion: We discuss these results and indications for different treatments of infected total knee arthroplasty. For each therapeutic option, we analysed factors allowing hope for cure and good functional outcome.
Conclusion: The objective of treatment of an infected TKA is to achieve cure and maintain satisfactory function, often a difficult goal to reach. Major mutilating surgery can be avoided by early adapted care.
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