Management of infected total knee arthroplasty

Deep wound infection after total knee arthroplasty is an infrequent but very serious complication. Treatment is difficult and challenging. Antibiotic therapy alone can not replace surgery in the management of infected total knee arthroplasty.

Fourteen infected total knee arthroplasties in 13 patients were treated by the author. Nine patients underwent two-stage reimplantation, one patient one-stage reimplantation, one patient arthroscopic debridement, and one patient knee fusion. Four knees in three patients were excluded because of less than 12 months follow-up. This study retrospectively analyzed the results of treatment in 10 infected total knee arthroplasties in 10 patients.

All patients were followed up for 12 months or longer. The length of follow-up ranged from 12 months to 69 months with an average of 28 months. All infections were successfully controlled, and there was no recurrence of infection. However, only 67% of the patients showed satisfactory functional results.

Based upon the results in this study, most of the infection after total knee arthroplasty could be successfully controlled by combined surgical treatment and intravenous antibiotic therapy. The result of two-stage reimplantation was more consistent and predictable. The functional result of infected total knee arthroplasty was less satisfactory as compared with that of the non-infected counterpart. Furthermore, the impact of infection or the longevity of total knee prosthesis could only be determined by long-term follow-up.