Abstract
Infection after TKA remains a common reason for reoperation, and represents a significant burden for the patient and health care system. Having effective treatment strategies, therefore, is important to ensure the highest possible rate of success, and the lowest possible rate of reoperation due to treatment failure. This lecture will focus on the chronically infected TKA, where treatment options include either one stage exchange or two stage exchange. Proponents of one stage exchange cite lower costs, less morbidity, and reasonable success rates when compared to two stage exchange protocols. One must realise that strict selection criteria are generally used by proponents of single stage exchange. Favorable pathogens, healthy hosts, good soft tissues, minimal bone loss, etc. are generally used as indications to consider one stage exchange. Such “ideal” clinical situations, however, are exceedingly rare. The overwhelming majority of infected TKA in my practice involve resistant bacteria, significant bone loss, hosts with medical comorbidity, and often, poor soft tissues. In these situations, two stage exchange remains the gold standard to which all other interventions should be compared. With few exceptions, the published success rates for two stage procedures have been better, albeit slightly, than those published for one stage exchanges. Both static and articulating cement spacers have been used with good results. Further research is needed to better define the most effective treatment protocols, however, until further information is available, two stage exchange, with success rates of 80–90%, remains the most successful intervention for chronically infected TKA.
