Treatment of Infected Total Knee Arthroplasty

ABSTRACT

Deep infection after total knee arthroplasty (TKA) represents a significant treatment challenge with the possibility of disastrous consequences. The rate of deep infection rate after TKA was reported to be 1.3~2.9% in the past. With the improvements of the operation environment and operative technique and the use of prophylactic antibiotics and antibiotic-mixed bone cement, the rate of deep infection was recently reported to be 0.5~1%. The goal of treatment of a periprosthetic TKA infection is the restoration of a painless, well-functioning joint, with eradication of the infection. Yet the outcome is not always favorable, and the end result could be an arthrodesis, amputation or a pseudoarthrodesis. In some instance, the only realistic option is to suppress the infection with continued oral antibiotics while simultaneously retaining the prosthesis. Two-stage resection arthroplasty remains the standard treatment for chronic periprosthetic infection. Early deep infection may be treated with aggressive debridement and intravenous antibiotics without removal of the implant. Two-stage reimplantation after removal of the implant is most important for the treatment of chronic infection.