ObjectiveTo summarize the clinical characteristics and treatment of acute cellulitis of shank after total knee arthroplasty. MethodsWe retrospectively analyzed the clinical data of five patients with delayed acute cellulitis of shank after total knee arthroplasty treated in our hospital between January 2008 and January 2013. The clinical characteristics, treatment and prognosis of the disease were then summarized and analyzed. ResultsThe delayed acute cellulitis of shank after total knee arthroplasty was mainly caused by tinea pedis, which resulted in skin damage and bacteria diffusion. The main clinical manifestations were pain and swelling around the knee joint and shank. The laboratory test found the increasing of C-reactive protein, erythrocyte sedimentation rate, white blood cell and neutrophils. Two cases were caused by hemolytic streptococcus according to blood culture. All patients were discharged after treatment without periprosthetic infection. ConclusionAccording to the typical clinical manifestations and laboratory test, the diagnosis of delayed acute cellulitis of shank is not difficult. Timely and comprehensive treatment should be emphasized to seek and eradicate the primary lesions, such as tinea pedis, subcutaneous ulcer and carbuncle.