Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

Total knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.

One-Stage Implant-Retaining Revision for Simultaneous Bilateral Infected Total Knee Arthroplasty: A Report of a Rare Case

There is little information on the management of simultaneous infected total knee arthroplasties in the same patient. Although general principles of management for periprosthetic joint infection apply, there might be certain aspects worth to be considered. We present a case of a 78-year-old patient, who was referred in preseptic conditions 10 years following bilateral TKA. The onset of symptoms was less than one week, proposing an acute hematogenous infection. Analysis of joint fluid revealed that both of his TKAs were infected with Streptococcus sanguinis. Diagnostic algorithms, surgical principles, and the course of the patients following bilateral revision are being described. The reasons for an implant-retaining procedure with irrigation and debridement including the exchange of the polyethylene liners are being discussed as well as possible principles of management of bilateral periprosthetic joint infections.

Reinfection Rate and Its Associated Factors after Two-Stage Revision for Infected Total Knee Arthroplasty

Background: Two-stage revision is the gold standard for treatment of infected total knee arthroplasty. The purpose of our study was to evaluate the reinfection rate of two-stage revision and to analyze the factors affecting the prognosis of two-stage revision for infected total knee arthroplasty.Methods: One hundred seven cases of two-stage revision for infected total knee arthroplasty were reviewed retrospectively from March 2006 to November 2019. We evaluated possible risk factors between success and reinfection groups. Statistical analyses included multivariable logistic regression analysis to examine the relative contribution of risk factors to the success of two-stage revision. Results: There were 19 cases of reinfection (17.8%) after two-stage revision in our center. Between the success and reinfection groups, there was a significant difference in history of cancer (p=0.015). Also, multivariable logistic regression analysis of risk factors demonstrated history of cancer (HR 5.928, p=0.015). There were no statistically significant differences in reinfection relative to other risk factors. Conclusions: In subjects undergoing two-stage revision for infected total knee arthroplasty, history of cancer was a risk factor for reinfection, though no other significant differences between risk factors was shown for reinfection.Trial registration: Retrospectively registeredLevel of evidence: IV

Mid-Term Results of Two-stage Revision Total Knee Arthroplasty for Infected Total Knee Arthroplasty

Introduction. Today, knee arthroplasty is one of the most common surgical procedures. Infection after endoprosthetics is the most dangerous complication in patients who have undergone total knee arthroplasty, which negatively affects the prognosis. Most cases of infection develop within the first 2 years after surgery, and the frequency is 1.5%, and after that it decreases to 0.5%. Material and Method. When a study group of 31 patients (22 female, 9 male) who were diagnosed with infected knee prosthesis and underwent two-stage revision knee prosthesis as a treatment method; the mean age of all patients (31 patients) was 68.78 years. In our study by using the American knee association scoring system; preoperative knee scores of 31 patients who underwent two-stage revision surgery were 35.43 ± 7.14, while this parameter was found to be 83.27 ± 8.89 postoperatively (p <0.01). Conclusion. We believe that two-stage revision surgery is an effective method in the treatment of infection that develops after primary total knee arthroplasty application. Restoration of the joint line in accordance with the anatomical structure will positively affect the clinical results, and the use of a long stem to increase the stability of the prosthesis is appropriate for successful results, especially in the cases with bone defects. Key words: Total Knee Arthroplasty, Two-Stage Revision Surgery, Infected Knee Prosthesis.