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Up to 2% of total knee arthroplasties (TKAs) are complicated by infection. This leads to dissatisfied patients with poor function, and has social and economic consequences. The challenge is the eradication of infection, restoration of full function, and prevention of recurrence…

…Infection of a TKA is a catastrophic complication for which we have yet to achieve optimal outcomes. The undeniable gold standard management of two-stage revision is associated with multiple morbidities and large expenditure.

Prosthesis sparing, aggressive early open debridement works for acute infections within 4 to 6 weeks of the index operation or of hematogenous seeding.

The role of single-stage revision is unclear, but with the success of one-stage hip revisions we have started to consider the single-stage knee revision in a highly selected cohort. For the two-stage revision arthroplasty antibiotic delivery can be improved by using antibiotic loaded cement and a mobile articulating antibiotic loaded spacer.

Management of infected arthroplasties requires an appropriate multi-disciplinary approach with close involvement of the infectious disease team to identify the pathogens involved and treat the patient appropriately.

By Fares S. Haddad, BSc, MCh(Orth), FRCS(Orth); Ademola Adejuwon, MRCS(Eng)
September 2007