The infected knee: all my troubles now

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials

Background:

• Infection following total knee arthroplasty (TKA) presents significant surgical challenges.
• Prompt diagnosis and identification of causative organisms with antibiotic sensitivities are crucial.
• Host factors, including nutritional status and smoking cessation, impact wound healing.

Purpose of the Study:

• To outline a standardized two-stage surgical protocol for managing periprosthetic joint infections after TKA.
• To highlight the benefits of an articulating antibiotic-cement spacer in the first stage of treatment.

Main Methods:

• Diagnosis of infection and identification of the microorganism and its antibiotic sensitivities.
• Surgical debridement of necrotic tissue and elimination of dead space.
• First stage: Placement of an articulating antibiotic-cement spacer to maintain limb length and tissue compliance.
• Second stage: Definitive reconstruction after infection control.

Main Results:

• The articulating spacer allows patients to maintain functional status between surgical stages.
• This approach facilitates more straightforward definitive reconstruction compared to static spacers.
• The clinical efficacy of this protocol is supported by existing literature.

Conclusions:

• A two-stage protocol utilizing an articulating antibiotic-cement spacer is an effective strategy for managing TKA infections.
• Maintaining limb length and tissue compliance with an articulating spacer aids in successful definitive reconstruction.
• Optimizing host healing capacity is essential for successful treatment outcomes.