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Managing the infected knee: as good as it gets
1Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
The Journal of Arthroplasty
|June 18, 2002
Summary
Treatment for infected total knee arthroplasty depends on presentation. Early infections or acute hematogenous infections in well-functioning prostheses may allow retention, while others require open débridement or two-stage reimplantation with local antibiotics.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials
Background:
- Infected total knee arthroplasty (TKA) presents a significant challenge in orthopedic surgery.
- Treatment selection is crucial for successful infection eradication and prosthesis function.
Purpose of the Study:
- To outline clinical strategies for managing infected total knee arthroplasty based on patient presentation.
- To provide guidance on surgical interventions and antibiotic delivery methods.
Main Methods:
- Review of clinical presentations guiding treatment decisions.
- Emphasis on open débridement over arthroscopic methods.
- Recommendation for two-stage reimplantation over direct exchange when prosthesis removal is necessary.
Main Results:
- Prosthesis retention is viable for infections within 30 days or acute late hematogenous infections in stable prostheses.
- Open débridement is preferred for debridement attempts.
- Delayed reconstructive techniques (two-stage reimplantation) are favored over direct exchange.
- Local antibiotic delivery via spacers or antibiotic-loaded cement/graft enhances cure rates.
Conclusions:
- Clinical presentation is key to tailoring infected TKA treatment.
- Open débridement and staged reimplantation with targeted local antibiotic delivery improve outcomes for infected TKA.