Skip to main content
SpringerLink
Log in

Managing Infection in Revision Total Knee Arthroplasty: A Practical Perspective

  • Chapter
  • First Online:
Revision Total Knee Arthroplasty

  • 503 Accesses

Abstract

The principles and concepts of managing periprosthetic joint infection rTKA are well-established. Early intervention in acute infections with thorough debridement and modular exchange is preferred. Patient selection, meticulous surgical debridement, and targeted antibiotic treatment in conjunction with a specialist microbiologist are the most important factors to ensure success in managing chronic PJI in either a single- or two-stage strategy. This chapter focuses on the practical aspects of managing infection in revision knee surgery and present our recent tertiary experience.

Wise and humane management of the patient is the best safeguard against infection.

Florence Nightingale

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Greidanus NV, et al. Quality of life outcomes in revision versus primary total knee arthroplasty. J Arthroplasty. 2011;26(4):615–20.

    Article  Google Scholar 

  2. Zmistowski B, et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am. 2013;95(24):2177–84.

    Article  Google Scholar 

  3. Blom AW, et al. Infection after total knee arthroplasty. J Bone Joint Surg Br. 2004;86(5):688–91.

    Article  CAS  Google Scholar 

  4. Huotari K, Peltola M, Jämsen E. The incidence of late prosthetic joint infections: a registry-based study of 112,708 primary hip and knee replacements. Acta Orthop. 2015;86(3):321–5.

    Article  Google Scholar 

  5. Kurtz SM, et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8):61-5.e1.

    Google Scholar 

  6. Meyer E, et al. Impact of department volume on surgical site infections following arthroscopy, knee replacement or hip replacement. BMJ Qual Saf. 2011;20(12):1069–74.

    Google Scholar 

  7. Mathews JA et al. Top ten research priorities for problematic knee arthroplasty. Bone Joint J. 2020;102-b(9):1176–82.

    Google Scholar 

  8. Parvizi J, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309-14.e2.

    Article  Google Scholar 

  9. Kilgus DJ, Howe DJ, Strang A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res. 2002;404:116–24.

    Article  Google Scholar 

  10. Romanò CL, et al. Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2445–53.

    Article  Google Scholar 

  11. Pangaud C, Ollivier M, Argenson JN. Outcome of single-stage versus two-stage exchange for revision knee arthroplasty for chronic periprosthetic infection. EFORT Open Rev. 2019;4(8):495–502.

    Article  Google Scholar 

  12. Kunutsor SK et al. Re-infection outcomes following one- and two-stage surgical revision of infected knee prosthesis: a systematic review and meta-analysis. PLoS One. 2016;11(3):e0151537.

    Google Scholar 

  13. Thakrar RR et al. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J. 2019;101-b(1_Supple_A):19–24.

    Google Scholar 

  14. Kubista B, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop. 2012;36(1):65–71.

    Article  Google Scholar 

  15. Mortazavi SM, et al. Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res. 2011;469(11):3049–54.

    Article  Google Scholar 

  16. Massin P, et al. Infection recurrence factors in one- and two-stage total knee prosthesis exchanges. Knee Surg Sports Traumatol Arthrosc. 2016;24(10):3131–9.

    Article  CAS  Google Scholar 

  17. Cunningham DJ, et al. Specific infectious organisms associated with poor outcomes in treatment for hip periprosthetic infection. J Arthroplasty. 2017;32(6):1984-90.e5.

    Article  Google Scholar 

  18. Matar HE et al. Septic revision total knee arthroplasty is associated with significantly higher mortality than aseptic revisions: long-term single-center study (1254 Patients). J Arthroplasty. 2021.

    Google Scholar 

  19. Corona PS et al. Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection. Bone Joint J. 2020;102-b(12):1682–88.

    Google Scholar 

  20. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302–45.

    Article  Google Scholar 

  21. James PJ, et al. Methicillin-resistant Staphylococcus epidermidis in infection of hip arthroplasties. J Bone Joint Surg Br. 1994;76(5):725–7.

    Article  CAS  Google Scholar 

  22. Matar HE et al. Long-term outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infections: changing clinical practice in a specialist centre (292 Knees). Bone Joint J. 2021;Aug;103-B(8):1373–9.

    Google Scholar 

  23. Li HK, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med. 2019;380(5):425–36.

    Article  CAS  Google Scholar 

  24. Leta TH et al. Outcome of revision surgery for infection after total knee arthroplasty: results of 3 surgical strategies. JBJS Rev. 2019;7(6):e4.

    Google Scholar 

  25. Vahedi H, et al. Irrigation, débridement, and implant retention for recurrence of periprosthetic joint infection following two-stage revision total knee arthroplasty: a matched cohort study. J Arthroplasty. 2019;34(8):1772–5.

    Article  Google Scholar 

  26. Barry JJ, et al. Irrigation and debridement with chronic antibiotic suppression is as effective as 2-stage exchange in revision total knee arthroplasty with extensive instrumentation. J Bone Joint Surg Am. 2021;103(1):53–63.

    Article  Google Scholar 

  27. Weston JT et al. Irrigation and debridement with chronic antibiotic suppression for the management of infected total knee arthroplasty: a contemporary analysis. Bone Joint J. 2018;100-b(11):1471–6.

    Google Scholar 

  28. Freeman MA, et al. The management of infected total knee replacements. J Bone Joint Surg Br. 1985;67(5):764–8.

    Article  CAS  Google Scholar 

  29. Fillingham YA et al. Definition of successful infection management and guidelines for reporting of outcomes after surgical treatment of periprosthetic joint infection: from the workgroup of the musculoskeletal infection society (MSIS). J Bone Joint Surg Am. 2019;101(14):e69.

    Google Scholar 

  30. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J. 2013;95-b(11 Suppl A):77–83.

    Google Scholar 

  31. Nagra NS, et al. One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(10):3106–14.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK

    Hosam E. Matar,  Benjamin V. Bloch & Peter J. James

  2. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

    Hugh U. Cameron

Authors
  1. Hosam E. Matar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin V. Bloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hugh U. Cameron
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter J. James
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hosam E. Matar .

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Matar, H.E., Bloch, .V., Cameron, H.U., James, P.J. (2021). Managing Infection in Revision Total Knee Arthroplasty: A Practical Perspective. In: Revision Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-81285-0_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81285-0_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81284-3

  • Online ISBN: 978-3-030-81285-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation