Periprosthetic Knee Infection - Part 2: Treatment

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Periprosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
• Variable success rates are reported for current treatment modalities.
• Effective management hinges on appropriate case selection for each therapeutic approach.

Purpose of the Study:

• To review and delineate the indications and decision-making processes for various treatment strategies for PJIs.
• To emphasize the importance of matching treatment to specific clinical scenarios and patient factors.

Main Methods:

• Review of current literature on periprosthetic infection management.
• Analysis of factors influencing the success of different treatment options.
• Categorization of treatments based on infection characteristics and implant status.

Main Results:

• Debridement with implant retention is suitable for acute infections with stable implants, contingent on infection type, host comorbidities, and pathogen virulence.
• One- or two-stage revision is necessary for biofilm formation or implant loosening.
• The choice between one- and two-stage revision depends on pathogen identification, virulence, and host factors.

Conclusions:

• Successful PJI treatment requires careful consideration of infection severity, biofilm presence, implant stability, and host-related factors.
• Rescue procedures like arthrodesis, amputation, or resection arthroplasty are reserved for refractory infections.
• Optimizing treatment selection is paramount for eradicating periprosthetic infections and improving patient outcomes.