Open AccessDiagnosis and management of the infected total knee replacement: a practical surgical guide
Author(s) -
Zahar Akos,
Sarungi Martin
Publication year - 2021
Publication title -
journal of experimental orthopaedics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 18
ISSN - 2197-1153
DOI - 10.1186/s40634-021-00333-2
Subject(s) - medicine , stage (stratigraphy) , expert opinion , multidisciplinary approach , total knee arthroplasty , arthroplasty , orthopedic surgery , debridement (dental) , surgery , intensive care medicine , general surgery , paleontology , social science , sociology , biology
Purpose Prosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a significant burden in health care. Diagnosis and proper management are challenging. A standardised procedure for the diagnostic workup and surgical management provides clear benefits in outcome. Methods Several diagnostic protocols and definitions for PJI were established in recent years. Proper PJI diagnosis remains critical for success and for choosing the optimal treatment option. A distinct workup of diagnostic steps, the evaluation of the results in a multidisciplinary setup and the meticulous surgical management of the infection are the key factors of successful treatment. Results The management of PJI after TKA consists of early revision with debridement and implant retention (DAIR) in early cases or staged revision in late infections beyond 30 days postoperative or after onset of acute symptoms. The revision is performed as a two‐stage procedure with the use of a fixed or mobile antibiotic spacer, or in selected cases as a single‐stage operation with the use of local and systemic antibiotic treatment. Conclusions This paper reflects the opinion of two revision surgeons who follow the same protocol for diagnosis and treatment of PJI after TKA, highlighting the key steps in diagnosis and management. Level of evidence Expert’s opinion