Treatment of acute hematogenous infection after total knee arthroplasty with open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic infusion: a midterm result with mean follow up of 75 months

Background: Standard management of acute hematogenous infection after total knee arthroplasty consisted of open arthrotomy debridement and polyethylene exchange. However, the efficacy of this method was inconsistent with successful retention could be less than 50%. Direct intra-articular antibiotic infusion could be a potential adjuvant for this complicated problem. Objective: To report our results of open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic for the treatment of acute hematogenous infection after TKA. Materials and Methods: We retrospectively review data from 16 knees (13 patients) with this type of infection and being treated by open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic (IA-ATB) with our protocol since 2009. Results: all cases were diagnoses with acute hematogenous PJI and treated with semi-urgent basis and underwent open arthrotomy debridement and PE exchange combined with IA-ATB with our protocol were included in this study. 2 cases (2 knees) were loss to follow up after the infection were eradicated at 7 months and 48 months. 2 cases (3 knees) passed away with intact prosthesis at 6 years. 2 cases (2 knees) were reinfected with at 2 years and 5 years after operation and later need to do 2 stage revision. The longest follow up was 11 years with average follow up of 75 months. Therefore, 12 out of 14 infected knees were successful treated with this technique. Conclusions: Open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic infusion is an effective method for the treatment of acute hematogenous infection after total knee arthroplasty.