Treatment of infected knee arthroplasty

Forty-eight patients with 51 infected knee arthroplasties were treated at the authors' institution between 1973 and 1986 and followed for 5.5 (range, 0-14) years. Six methods to treat the infections were employed: antibiotics only, soft-tissue surgery, removal of the prosthesis, revision arthroplasty, arthrodesis, and amputation. Failure of the initial surgical treatment led to second revision surgery in 20 patients. At the follow-up examination, three patients (five knees) had died from septic complications and two patients had had above-knee amputation. Two of 32 patients had been successfully treated with antibiotics with no additional surgery. Four patients had successful soft-tissue surgery. Following removal of the prosthesis, the infection healed in four patients. In 12 of 19 patients (13 knees) with revision arthroplasty the infection healed, but only seven of these had functioning prostheses. The infection healed in all but one of the 21 patients with arthrodeses, and all but two were fused. Infected compartmental prostheses with good bone stock can be treated with an exchange arthroplasty using a two-stage procedure with tricompartmental revision prostheses. Otherwise, an arthrodesis using a two-stage procedure is recommended for the treatment of infected knee arthroplasty.