Reinfected revised TKA resolves with an aggressive protocol and antibiotic infusion

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Arthroplasty Research

Background:

• Revision total knee arthroplasty (TKA) for infection presents significant challenges.
• Amputation is often the only recourse for managing failed TKA revisions due to infection.

Purpose of the Study:

• To evaluate the efficacy of an aggressive revision protocol combined with intraarticular antibiotic infusion.
• To determine if reinfection after two-stage revision TKA for infection can be successfully managed.

Main Methods:

• Retrospective review of 18 patients undergoing revision for failed reimplantation due to infection.
• Treatment involved extensive débridement, uncemented components, soft tissue reconstruction (muscle flaps/plastic surgery), and 6-week intraarticular antibiotic infusion via Hickman catheters.
• Follow-up averaged 6.1 years.

Main Results:

• Seventeen of 18 patients achieved infection control, durable fixation, and wound healing.
• Mean Knee Society scores improved significantly from 33 to 76.
• One patient required amputation due to failed soft tissue closure; another had a recurrent infection successfully managed with repeat débridement and antibiotic infusion.

Conclusions:

• An aggressive surgical approach, including extensile exposure, thorough débridement, and soft tissue flaps, is crucial.
• Uncemented fixation for revision implants and intraarticular antibiotic infusion effectively controlled reinfection post-TKA.
• This protocol offers a successful alternative to amputation in managing complex revision TKA infections.