What is the best Management Solution Of Infected Total Knee Arthroplasty?

Introduction: Diagnosis and treatment of infections after total knee arthroplasty (TKA) is the most difficult and not fully resolved issue.

Objectives: The purpose of our study was to create and evaluate different management protocols depending on time of occurrence and severity of infection after TKA.

Methods: From 1997 to 2015, we performed 1229 TKA (1187 non-constrained/42 constrained). Age: 39–85 y.o. Male/Female: 515/714. Persistent knee pain was presented in 189 (15.4%) patients; in 81 we suspected infection. Examination: clinical, X-ray/CT, bone scanning, aspirations(3), biopsy; laboratory, synovial fluid tests; tensionfistulography, PCR. Management protocols. Early infection (3 months): 8 patients — arthrotomy; single-stage revision - 8. Chronic infection (>3 months): single-stage revision - 11. (In favourable conditions), two-stage revision (8 patients). We implanted customized articulating spacer (using polyethylene insert) with antibiotics. Reimplantation: 8–14 weeks after surgery. Arthrodesis (20 patients).

Results (62 patients): mean follow-up 4.4 years. Early infection. Conservative treatment efficiency - 9%.; arthroscopic debridement - 25%; arthrotomy - 61.6%. Late. Arthrotomy: infection recurrence - 100%, Single-stage revision: 30% ( in 6 - 25 weeks). Chronic infection. Single-stage revision: infection recurrence - 37% (6–35 weeks). Two-stage: infection eradication - 100%. The arthrodesis efficiency - 93%.

Conclusions: A decision of performing revision surgery could be taken after complex patient examination and finding a reason of endoprosthesis instability.