Management of infection at the site of a total knee arthroplasty

Infection following total knee arthroplasty remains a major complication in joint reconstruction, resulting in significant morbidity to the patient and increased hospital costs. The diagnosis of infection is often made based on clinical criteria, although adjunctive measures including blood work, plain radiographs, and arthrocentesis are often helpful in confirming the diagnosis and planning subsequent treatment. For patients in whom the diagnosis of infection cannot be immediately confirmed, an acute intraoperative tissue analysis by a skilled pathologist and experienced surgeon is required. Treatment of this complication is directed by the chronicity of the infection, stability of the components, and medical status of the patient. Although débridement with component retention may be successful in the acute postoperative stage of joint replacement, a two-staged revision with removal of all components followed by an adequate course of parenteral antibiotics prior to reimplantation remains the gold standard for eradicating chronic infection. The addition of antibiotic-impregnated cement spacers (static or articulating) has also been implicated as a useful adjunct to treatment. Long-term suppressive antibiotic treatment, arthrodesis, resection arthroplasty, and amputation are reserved for specific clinical situations in which a staged revision or débridement are unlikely to yield favorable results.