THE MANAGEMENT AND OUTCOMES OF INFECTED TOTAL KNEE ARTHROPLASTY

Abstract

Infection is one of the most disturbing and frightening complications of total knee arthroplasty (TKA). The purpose of the present study was to review the management and outcomes of infected total knee arthroplasty.

The management and outcomes in 71 patients with 71 infected TKA was reviewed. Two-stage reimplantation with 8 weeks of intravenous therapy between the stages was used in 49 patients. Twenty-four patients ended with an arthrodesis using external fixation or intramedulary (IM) nailing. A two-stage technique was used with IM nail arthrodesis. Infections after TKA associated with bone destruction and loss were treated using an antibiotic-impregnated cement rod-spacer. Two patients required amputation: one because of soft tissue necrosis around the knee, another because of recalcitrant infection. In two patients the antibiotic-impregnated cement rod-spacer was chosen as a definitive treatment. The re-infection rate was about 25%. In most cases of reinfection the pathogens were the same, but of higher virulence and resistance. Infection was eradicated in 85% of patients. More than half of patients ended up with a functional TKA (average function score was 86.5 points, average range of motion from 2 to 109 degrees). One third of patients had a solid fusion. The infection could not be eradicated in 15% of patients.

The management and outcomes of infected total knee arthroplasty depend on a rapid and accurate diagnosis. A clear and effective management algorithm should yield favorable outcomes according to well-defined criteria. The two-stage reimplantation is the treatment of choice for chronic periprosthetic knee infection. Knee arthrodesis can be an effective treatment option after the failure of a TKA due to infection.