The Infected Total Knee Arthroplasty

Abstract

Deep infection is one of the most devastating complications of total knee arthroplasty (TKA). The incidence of infection after TKA ranges from 1.1% to 12.4%. Multiple risk factors for infection in total joint arthroplasty have been identified, including diabetes mellitus, rheumatoid arthritis, use of immunosuppressive medications, renal failure, cardiopulmonary insufficiency, and the presence of skin ulcerations. Effective diagnosis requires a high index of suspicion and the concomitant use of multiple diagnostic modalities. Treatment goals for an infected TKA include eradication of infection, pain relief, and maintenance of a functional lower extremity. Currently, two-stage reimplantation is the gold standard in the treatment of late chronic periprosthetic knee infections. The protocol consists of removal of the prosthesis and cement, thorough débridement of soft tissue and bone, 6 weeks of intravenous antibiotics, and then reimplantation of a new prosthesis. This technique gives the most predictable result for eradication of infection and has the advantage of improved functional outcome compared with arthrodesis, definitive resection arthroplasty, or amputation.

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