Two-stage Total Knee Arthroplasty for Treatment of Surgical Failure of Septic Arthritis in Degenerative Knee Joints

Background: The ultimate goal of the treatment of infectious knee arthritis is to protect the articular cartilage fromadverse effects of infection. Treatment, however, is not always hundred percent successful and has a 12% failurerate. Persistent infection is more likely to happen in elderly patients and those with underlying joint diseases,particularly osteoarthritis. Eradication of infection and restoration of function in the involved joint usually arenot possible by conventional treatment strategies. There are few case series reporting two-stage primary kneearthroplasty as the salvage treatment of the septic degenerative knee joint; however, the treatment protocol remainsto be elucidated.Methods: Based on a proposed approach, patients with failure of common interventions for treatment of septic kneearthritis and underlying joint degeneration were treated by two-stage TKA and intervening antibiotic loaded staticcement spacer. Suppressive antibiotic therapy was not prescribed after the second stage.Results: Complete infection eradication was achieved with mean follow up of 26 months. All cases were balanced withprimary total knee prosthesis. The knee scores and final range of motions were comparable to other studies.Conclusion: The two-stage total knee replacement technique is a good option for management of failure of previoussurgical treatment in patients with septic arthritis and concomitant joint degeneration. Our proposed approach enabledus to use primary prosthesis in all of our patients with no need for suppressive antibiotic therapy.Level of evidence: IV