Diagnosis and Management of Infected Total Knee Arthroplasty§
Niraj V Kalore1, Terence J Gioe1, Jasvinder A Singh*, 1, 2, 3
1Minneapolis VA Medical Center and University of Minnesota, Minneapolis, USA
2Mayo Clinic College of Medicine, Rochester, MN, USA
3Birmingham VA Medical Center and University of Alabama, Birmingham, AL, USA
Infection following total knee arthroplasty can be difficult to diagnose and treat. Diagnosis is multifactorial and relies on the clinical picture, radiographs, bone scans, serologic tests, synovial fluid examination, intra-operative culture and histology. Newer techniques including ultrasonication and molecular diagnostic studies are playing an expanded role. Two-stage exchange arthroplasty with antibiotic cement and 4-6 weeks of intravenous antibiotic treatment remains the most successful intervention for infection eradication. There is no consensus on the optimum type of interval antibiotic cement spacer. There is a limited role for irrigation and debridement, direct one-stage exchange, chronic antibiotic suppression and salvage procedures like arthrodesis and amputation. We examine the literature on each of the diagnostic modalities and treatment options in brief and explain their current significance.
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* Address correspondence to this author at the University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA; Tel: 205-934-8158; Fax: 205-966-9685; E-mail: firstname.lastname@example.org