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Infected total knee arthroplasties
Abstract:
Thirty infected total knee arthroplasties were investigated in 29 patients over an average interval of 42 months. Eleven infections began in the immediate perioperative period. Six developed from postoperative wound-healing problems. The remainder were late infections. Staphylococcus was found in 16 infections, gram-negative agents in five, mixed organisms in five, and other gram-positives in four. Sixteen knees were arthrodesed, six knees were treated by retention of the components, and two above-knee amputations and one resection arthroplasty were performed. Five patients had two-stage revisions to new components. Evidence of persistent infection was present in three arthrodeses, two retained arthroplasties, and one knee that was revised. Perioperative infections were associated with staphylococcal organisms and responded less favorably to conservative treatment. The failure of primary wound healing demands immediate measures to obtain skin coverage. Retention of the arthroplasty components is possible only in selected patients.
Insights
This study on infected total knee arthroplasties found that perioperative infections, often caused by Staphylococcus, respond poorly to conservative treatment. Prompt wound management and careful patient selection are crucial for successful outcomes in infected knee replacements.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Infected total knee arthroplasty (TKA) presents significant challenges in patient management and treatment outcomes.
- Understanding the timing, causative organisms, and treatment strategies for TKA infections is critical for improving clinical practice.
Purpose of the Study:
- To investigate the characteristics and outcomes of infected total knee arthroplasties.
- To identify factors associated with treatment success and failure in TKA infections.
Main Methods:
- Retrospective analysis of 30 infected TKAs in 29 patients over an average of 42 months.
- Categorization of infections by onset (perioperative, wound healing, late) and identification of causative microorganisms.
- Evaluation of various treatment modalities, including arthrodesis, component retention, revision arthroplasty, and amputation.
Main Results:
- Staphylococcus was the most common pathogen (16 infections).
- Perioperative infections were linked to Staphylococcus and showed less favorable responses to conservative management.
- Treatment outcomes varied, with persistent infection noted in arthrodesis, retained arthroplasties, and revised knees.
Conclusions:
- Early detection and management of wound healing problems are essential in TKA infections.
- Conservative treatment of perioperative infections, particularly those caused by Staphylococcus, is often less successful.
- Successful management of infected TKA requires tailored treatment strategies based on infection type and patient selection, with component retention being feasible only in select cases.