The Infected Total Knee Arthroplasty Part 2: Management Options

total knee arthroplasty. Part 1 in the series, published in the January 2006 issue of Hospital Physician, reviewed evaluation, diagnosis, and classification of infection from a primary care physician’s perspective. This article discusses management of total knee arthroplasty infection from a surgical perspective. Once the diagnosis of deep infection has been established, a number of factors must be considered to determine the appropriate treatment: the duration of time between the index arthroplasty and the diagnosis of infection; the pathogen(s) responsible for infection and subsequent antibiotic sensitivities; host factors that may adversely affect successful treatment; status of the soft tissue envelope and the extensor mechanism; whether the arthroplasty is fixed or loose; and assessment of the patient’s expectations and functional demands. Treatment goals for an infected total knee arthroplasty are eradication of infection, pain relief, and maintenance of a functional lower extremity. Secondary attempts to eradicate infection after a treatment failure are often hindered and adversely affected by progressive arthrofibrosis, devitalization of the soft tissue envelope, additional bone loss, and the possible development of antibiotic-resistant organisms. Therefore, it is important to achieve the best possible outcome with the first treatment attempt. The 6 basic treatment options for an infected total knee arthroplasty include: (1) antibiotic suppression, (2) open débridement, (3) resection arthroplasty, (4) arthrodesis, (5) amputation, and (6) single-staged or 2-staged resection and reimplantation of another prosthesis.