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The infected total knee: management options.

John M Cuckler¹

¹Division of Orthopaedic Surgery, University of Alabama at Birmingham, FOT 930, 1530 3rd Avenue South, Birmingham, AL 35294, USA.

The Journal of Arthroplasty

|July 2, 2005

Summary

Managing infection after total knee replacement involves a two-stage approach. This includes removing implants, using antibiotic spacers, and reimplanting with antibiotic cement for better outcomes.

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Area of Science:

Orthopedic Surgery
Infectious Disease Management
Biomaterials Science

Background:

Periprosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA).
Effective management strategies are crucial for limb salvage and patient recovery.
Current approaches often involve staged surgical interventions and targeted antibiotic therapy.

Purpose of the Study:

To evaluate the efficacy of a two-stage salvage protocol for managing infected total knee arthroplasty.
To assess the outcomes of using antibiotic-impregnated cement spacers in TKA infections.
To present the author's experience with 44 cases of infected knee arthroplasty.

Main Methods:

Two-stage salvage procedure involving implant and cement removal.
Placement of an antibiotic spacer (static or articulated) with antibiotic-impregnated cement.
Intravenous antibiotic therapy followed by reimplantation with antibiotic-impregnated cement.

Main Results:

The two-stage approach demonstrated successful management of infected TKAs.
Articulated spacers facilitated maintenance of joint motion and bone stock.
The protocol was applied to 44 cases, with outcomes detailed in the report.

Conclusions:

Two-stage salvage with antibiotic spacers is a predominant and effective strategy for TKA infections.
Maintaining motion and bone stock with articulated spacers can improve functional outcomes.
Successful management depends on infection chronicity, host factors, and bacterial sensitivity.

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