[Infection of knee endoprosthesis]

In knee arthroplasties, infection was and still is the most decisive factor with respect to the end result. Control of infection without removal of the endoprosthesis can be achieved only when an early revision is performed in the first 6 weeks after the arthroplasty. Half-hearted antibiotic medication alone is an unsuitable remedy. Therefore, an infection must be diagnosed without delay and followed up by decisive management. Clinical and laboratory data must be considered together and must supplement each other. Late infections need temporary or permanent removal of the endoprosthesis as a prerequisite for getting rid of the infection. Reimplantation and arthrodesis should be done in a two-stage procedure after the infection is healed. Reimplantation should be restricted to cases in which the infection is definitely under control and in which there is a good bone stock. Arthrodesis is still the treatment of choice, especially in patients with bony defects in the metaphysis of the femur and tibia. Arthrodesis also needs good soft tissue cover, and to prevent a reinfection in this dangerous area we suggest the use of antibiotic-releasing bone plates for stabilisation. External fixation has a high percentage of pintrack infections and often cannot be applied long enough; thus non-unions are the logical consequence.