Diagnosis and Management of Infected Total Knee Arthroplasty§

Niraj V Kalore1, Terence J Gioe1, Jasvinder A Singh*, 1, 2, 3
1 Minneapolis VA Medical Center and University of Minnesota, Minneapolis, USA
2 Mayo Clinic College of Medicine, Rochester, MN, USA
3 Birmingham VA Medical Center and University of Alabama, Birmingham, AL, USA

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© Kalore et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* 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:


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.

Keywords: Infection, Diagnosis, management, total Knee arthroplasty, knee replacement, periprosthetic infection.