RESEARCH ARTICLE


Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment



Juan Carlos Martínez-Pastor*, Francisco Maculé-Beneyto, Santiago Suso-Vergara
Department of Orthopaedics and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain


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© Martínez-Pastor et al.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/) which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Orthopaedics and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain; Tel: +34932275400, Ext. 5533; E-mail: jcmartin@clinic.ub.es


Abstract

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series. For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%).

Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs.

The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors.

Keywords: : Acute haematogenous infections, Acute post-operative infections, Biofilm, Implant retention, Open debridement, Total knee arthroplasty.