MANAGEMENT OF DEEP INFECTION AFTER TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Zhenhui , WANG Lei , SUN Yunbo , CAO Jiangang , ZHANG Yu , TIAN Mengqiang , LIU Jun.

Department of Orthopedics, Tianjin Peoples’ Hospital, Tianjin, 300121, P.R.China. Corresponding author: LIU Jun, E-mail: drliu-jun@hotmail.com;

Corresponding author：

Keywords：

Total knee arthroplasty; Deep infection; Postoperative complication

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the clinical treatment methods of deep infection after total knee arthroplasty (TKA) and its effectiveness. Methods Between January 2004 and January 2010, 32 cases (32 knees) of deep infection after TKA were treated, including 13 males and 19 females with an average age of 64.6 years (range, 52-79 years). The time from primary TKA to infection was 3 weeks to 10 years. The preoperative knee society score (KSS) was 104.6 ± 9.1, and the visual analogue scale (VAS) score was 7.8 ± 1.4. Open debridement and continuous irrigation were perfomed in 3 cases of acute infection, arthroscopic debridement and irrigation in 3 cases of acute haematogenous infection; in 26 cases of chronic deep infection, 9 cases underwent open debridement, 4 cases underwent antibiotics impregnated bone cement spacer, 12 cases received two-stage revision, and 1 case underwent conservative treatment by intravenous antibiotics. Results All cases of acute infection failed to control deep infection; 1 case of acute haematogenous infection failed to treat; 7 cases of chronic infection undergoing debridement and 1 case of conservative treatment failed to treat; and all the failure cases were cured after symptomatic treatment. Thirty-two cases were followed up 2-8 years (mean, 4.6 years). At last follow-up, the KSS score and VAS score were 158.4 ± 8.3 and 4.1 ± 0.8, respectively, all showing significant differences when compared with preoperative scores (P lt; 0.05). Re-infection occurred in 3 patients who received two-stage revision during follow-up. Conclusion In patients with acute infection of methicillin-resistant Staphylococcus aureus after TKA, open debridement and liner change have low success rate; arthroscopic debridement can be performed to control acute haematogenous infection; and two-stage revision is an effective method to control chronic infection and restore the knee function, but two-stage revision has a potential risk of re-infection.

Citation： SUN Zhenhui,WANG Lei,SUN Yunbo,CAO Jiangang,ZHANG Yu,TIAN Mengqiang,LIU Jun.. MANAGEMENT OF DEEP INFECTION AFTER TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(8): 918-921. doi: Copy

1.	Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics, 2008, 31(6): 581-588.
2.	Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect, 2008, 57: 305-315.
3.	Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A(Suppl 1): S75-80.
4.	Kubista B, Hartzaler RU, Wood CM, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop, 2012, 36(1): 65-71.
5.	Savarino L, Tigani D, Baldini N, et al. Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 667-675.
6.	Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am), 2010, 92(11): 2102-2109.
7.	Matthews PC, Berendt AR, McNally MA, et al. Diagnosis and management of prosthetic joint infection. BMJ, 2009, (338): b1773.
8.	Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics, 2010, 33(9): 659.
9.	Hanssen AD. Managing the infected knee: as good as it gets. J Arthroplasty, 2002, 17(4 Suppl 1): 98-101.
10.	Sener N, Asik M, Tözün IR, et al. Infekte total diz artroplastisinde debridmant antibiyotik süpresyonu. Acta Orthop Traumatol Turc, 1998, 32(5): 408-410.
11.	Estes CS, Beauchamp CP, Clarke HD, et al. A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8): 2029-2038.
12.	Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty, 2009, 24(6 Suppl): 101-104.
13.	Ilahi OA, Al-Habbal GA, Bocell JR, et al. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy, 2005, 21(3): 303-306.
14.	Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res, 1988, (236): 23-35.
15.	Macheras GA, Kateros K, Galanakos SP, et al. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg (Br), 2011, 93(11): 1487-1492.
16.	余世明, 张紫机, 盛璞义, 等. 两种间隔器在膝关节置换术后假体感染的二期翻修术中应用的比较和分析. 中华关节外科杂志(电子版), 2010, 4(4): 482-487.
17.	Lee J, Kang CI, Lee JH, et al. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect, 2010, 75(4): 273-276.
18.	Ocguder A, Firat A, Tecimel O, et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg, 2010, 130(6): 719-725.
19.	Neogi DS, Kumar A, Yadav CS, et al. Delayed periprosthetic tuberculosis after total knee replacement: is conservative treatment possible? Acta Orthop Belg, 2009, 75(1): 136-140.

1. Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics, 2008, 31(6): 581-588.
2. Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect, 2008, 57: 305-315.
3. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A(Suppl 1): S75-80.
4. Kubista B, Hartzaler RU, Wood CM, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop, 2012, 36(1): 65-71.
5. Savarino L, Tigani D, Baldini N, et al. Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 667-675.
6. Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am), 2010, 92(11): 2102-2109.
7. Matthews PC, Berendt AR, McNally MA, et al. Diagnosis and management of prosthetic joint infection. BMJ, 2009, (338): b1773.
8. Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics, 2010, 33(9): 659.
9. Hanssen AD. Managing the infected knee: as good as it gets. J Arthroplasty, 2002, 17(4 Suppl 1): 98-101.
10. Sener N, Asik M, Tözün IR, et al. Infekte total diz artroplastisinde debridmant antibiyotik süpresyonu. Acta Orthop Traumatol Turc, 1998, 32(5): 408-410.
11. Estes CS, Beauchamp CP, Clarke HD, et al. A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8): 2029-2038.
12. Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty, 2009, 24(6 Suppl): 101-104.
13. Ilahi OA, Al-Habbal GA, Bocell JR, et al. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy, 2005, 21(3): 303-306.
14. Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res, 1988, (236): 23-35.
15. Macheras GA, Kateros K, Galanakos SP, et al. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg (Br), 2011, 93(11): 1487-1492.
16. 余世明, 张紫机, 盛璞义, 等. 两种间隔器在膝关节置换术后假体感染的二期翻修术中应用的比较和分析. 中华关节外科杂志(电子版), 2010, 4(4): 482-487.
17. Lee J, Kang CI, Lee JH, et al. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect, 2010, 75(4): 273-276.
18. Ocguder A, Firat A, Tecimel O, et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg, 2010, 130(6): 719-725.
19. Neogi DS, Kumar A, Yadav CS, et al. Delayed periprosthetic tuberculosis after total knee replacement: is conservative treatment possible? Acta Orthop Belg, 2009, 75(1): 136-140.

Chinese Journal of Reparative and Reconstructive Surgery

MANAGEMENT OF DEEP INFECTION AFTER TOTAL KNEE ARTHROPLASTY

Abstract Full text Figures/Tables Video References Cited by

Format

Content