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.

A number of therapeutic strategies exist for the management of infected TKA with the accepted gold standard being two-stage revision arthroplasty combined with intravenous antibiotic therapy. This usually is associated with long periods of hospitalization, difficult mobility, pain, and financial ramifications. As a result novel and less aggressive approaches are being attempted. Prosthesis sparing early aggressive debridement in the acutely infected knee, antibiotics, and single-stage knee revision should be considered.

Conclusion

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.