Advertisement

The Infected Total Knee Arthroplasty

  • Edward T. Habermann

Abstract

Sepsis following total knee arthroplasty is a catastrophic complication. Its management can be one of the most challenging and frustrating experiences in orthopaedic surgery. While infection is not the most frequent complication seen in total knee arthroplasty, it is probably the most dreaded. The incidence of deep infection following total knee arthroplasty has varied from less than 1% (Grogan . 1986; Insall 1986; Insall . 1983a; Poss . 1984) to greater than 20% (Jones . 1979) with the highest incidence being reported with early designs that used the hinged type of metal to metal bearing surface. With the more recently designed total knees, there has been a reduction in the incidence of deep infection to a level of from 1% to 5% (Insall 1986; Rand . 1986). Although this reduction is admirable, the incidence is still markedly higher than that seen following knee operations in which an implant is not utilized.

Keywords

Total Knee Arthroplasty Total Knee Replacement Total Joint Arthroplasty Resection Arthroplasty Total Knee Prosthesis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bengtson S, Knutson K, Lidgren L, (1989) Treatment of infected knee arthroplasty. Clin Orthop 245: 173–180Google Scholar
  2. Bigliani L, Rosenwasser M, Caulo N, . (1983) The use of pulsing electromagnetic fields to achieve arthrodesis of the knee following total knee arthroplasty. J Bone Joint Surg (Am) 65: 480–485Google Scholar
  3. Blomgren G, Lindgren U, (1980) The susceptibility of total joint replacement to hematogenous infection in the early postoperative period: an experimental study in the rabbit. Clin Orthop 151: 308–320PubMedGoogle Scholar
  4. Borden LS, Gearen TF, (1987) Infected total knee arthroplasty: a protocol for management. J Arthroplasty 2: 27–32PubMedCrossRefGoogle Scholar
  5. Brodersen MP, Fitzgerald RH, Peterson LPA, Coventry MB, Bryan RS, (1979) Arthrodesis of the knee following failed total knee arthroplasty. J Bone Joint Surg (Am) 61: 181–185Google Scholar
  6. Carlsson AS, Lindren L, Lindberg I, (1977) Prophylactic antibiotics against early and late deep infections after total hip replacements. Acta Orthop Scand 48: 405–410PubMedCrossRefGoogle Scholar
  7. Coonse K, Adams JD, (1943) A new operative approach to the knee joint. Surg Gynecol Obstet 77: 344–347Google Scholar
  8. Costerton JW, Geesey GG, Chenk KJ, (1978) How bacteria stick. Sci Am 238: 86–95PubMedCrossRefGoogle Scholar
  9. Deutman K, Mulder THJ, Brian R, Nater JP, (1977) Metal sensitivity before and after total hip arthroplasty. J Bone Joint Surg (Am) 59: 862–865Google Scholar
  10. Elson RA, (1985) Antibiotic loaded acrylic cement. In: Uthoff HG, (ed) Current concepts of infections in orthopaedic surgery. Springer-Verlag, Berlin, pp 247–250CrossRefGoogle Scholar
  11. Falahee MH, Matthews LS, Kaufer H, (1987) Resection arthroplasty as a salvage procedure for a knee with infection after total arthroplasty. J Bone Joint Surg (Am) 69: 1013–1019Google Scholar
  12. Fitzgerald RH, Kelly PJ (1979) Total joint arthroplasty: biological causes of failure. Mayo Clin Proc 54: 590–595PubMedGoogle Scholar
  13. Freeman M, Sudlow R, Casewell M, Radcliff S, (1985) The management of infected total knee replacements. J Bone Joint Surg (Br) 67: 764–768Google Scholar
  14. Green SA, (1975) The effect of methylmethacrylate on phagocytosis. In: Proceedings of the Orthopaedic Research Society. J Bone Joint Surg (Am) 57: 583Google Scholar
  15. Gristina A, Costerton J, (1985) Bacterial adherence to biomaterials and tissue. J Bone Joint Surg (Am) 67: 264–273Google Scholar
  16. Gristina AG, Kolkin J, (1983) Total joint replacement and sepsis - current concepts review. J Bone Joint Surg (Am) 65: 128–138Google Scholar
  17. Gristina AG, Rovedre GD, Shoji H, Nicastro JF, (1976) An in vitro study of bacterial response to inert and reactive metals and to methylmethacrylate. J Biomed Mater Res 10: 273–281PubMedCrossRefGoogle Scholar
  18. Gristina AG, Costerton JW, Leake E, Kolkin J, (1980) Bacterial colonization of biomaterials. Clinical and laboratory studies. Orthop Trans 4: 355Google Scholar
  19. Grogan TJ, Dorey F, Rollins J, Amstutz HC, (1986) Deep sepsis following total knee arthroplasty. J Bone Joint Surg (Am) 68: 226–232Google Scholar
  20. Hagemann WF, Woods GW, Tullos HS, (1978) Arthrodesis in failed total knee replacement. J Bone Joint Surg (Am) 60: 790–794Google Scholar
  21. Hill C, Flamant R, Mazas F (1981) Prophylactic cefazolin versus placebo in total hip replacement. Report of a multicentre double blind randomized trial. Lancet i: 795–797Google Scholar
  22. Insall JN, (1986) Infection of total knee arthroplasty. In: Anderson LD, (ed) AAOS instructional course lectures, vol 25. CV Mosby, St. Louis, p 319Google Scholar
  23. Insall JN, Hood RW, Flawn LB, Sullivan DJ (1983a) The total condylar knee prosthesis in gonarthrosis. J Bone Joint Surg (Am) 65: 619–625Google Scholar
  24. Insall J, Thompson F, Brause B (1983b) Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg (Am) 65: 1087–1098Google Scholar
  25. Johnson DP, Bannister GC, (1986) The outcome of infected arthroplasty of the knee. J Bone Joint Surg (Br) 68: 289–291Google Scholar
  26. Jones EC, Insall JN, Inghs AE, Ranawat CS, (1979) GUEPAR knee arthroplasty results and late complications. Clin Orthop 140: 145–152PubMedGoogle Scholar
  27. Knutson K, Hovelius L, Lindstrand A, Lindgren L, (1985) Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases. Clin Orthop 191: 202–210Google Scholar
  28. Leake ES, Wright MJ, Gristina AG, Earle CP, (1980) Macrophage attachment and bacterial colonization of biomaterials. Presented as a poster session at the National Meeting of the Reticuloendothelial Society, Tampa, FloridaGoogle Scholar
  29. McCraw JB, Fishman JH, Sharzar LA, (1978) The versatile gastrocnemius myocutaneous flap. Plast Reconst Surg 62: 15–23PubMedCrossRefGoogle Scholar
  30. Morrey BF, Westhold OPA, Schoifet S, Rand JA, Bryan RS, (1989) Long term results of various treatment options for infected total knee arthroplasty. Clin Orthop 248: 120–130PubMedGoogle Scholar
  31. Norden CW, (1983) A critical review of antibiotic prophylaxis,in orthopaedic surgery. Rev Infect Dis 5: 928–932PubMedCrossRefGoogle Scholar
  32. Norden CW, (1985) Prevention of bone and joint infections. Am J Med 78 (Suppl 6B): 229–232PubMedCrossRefGoogle Scholar
  33. Perry C, Davenport K, Vossen M (1988) Local delivery of antibiotics via an implantable pump in the treatment of osteomyelitis. Clin Orthop 226: 222–230PubMedGoogle Scholar
  34. Petty W, Sapnier S, Schuyster J, Silverthorne C, (1985) The influence of skeletal implants on incidence of infection. J Bone Joint Surg (Am) 67: 1236–1244Google Scholar
  35. Pollard JP, Hughest SPF, Scott JE, . (1979) Antibiotic prophylaxis in total hip replacement. Br Med J i: 707–709Google Scholar
  36. Poss R, Thornhill TS, Ewald FC, . (1984) Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop 182: 117–126PubMedGoogle Scholar
  37. Rae T, (1975) A study of the effects of particulate metals of orthopaedic interest on murine macrophages in vitro. J Bone Joint Surg (Br) 57: 444–450Google Scholar
  38. Rand J, Bryan R, (1983) Reimplantation for the salvage of an infected total knee arthroplasty. J Bone Joint Surg (Am) 65: 1081–1086PubMedGoogle Scholar
  39. Rand J, Morrey B, Bryan R, (1984) Management of the infected total joint arthroplasty. Orthop Clin N Am 15: 491–504Google Scholar
  40. Rand JA, Peterson LFA, Bryan RS, Astrup DM, (1986) Revision total knee arthroplasty. In: Anderson LD, (ed) AAOS instructional course lectures, vol 25. CV Mosby, St. Louis, p 305Google Scholar
  41. Rasp PL, Clawson CC, Hoidal JR, Repine JE, (1979) Quantitation and scanning electron microscopic comparison of human alveolar macrophage and polymorphonuclear leukocyte adherence to nylon fibers in vitro. J Retic Soc 25: 101–109Google Scholar
  42. Salibian AH, Anzel SH, (1983) Salvage of an infected total knee prosthesis with medial and lateral gastrocnemius muscle flaps. J Bone Joint Surg (Am) 65: 681–684PubMedGoogle Scholar
  43. Salvati EA, Insall JN, (1980) The management of sepsis in total knee replacements. In: Savastano AA, (ed) Total knee replacements. Appleton-Century Crofts, New York, pp 49–58Google Scholar
  44. Salvati EA, Robinson RP, Zeno SM, . (1982) Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered airflow system. J Bone Joint Surg (Am) 64: 525–531PubMedGoogle Scholar
  45. Sanders R, O’Neill T, (1981) The gastrocnemius myocutaneous flap used as a cover for the exposed knee prosthesis. J Bone Joint Surg (Br) 63: 383–396PubMedGoogle Scholar
  46. Scott RD, Saliski JM, (1985) The use of a modified V-Y quadricepsplasty during total knee replacement to gain exposure and improve flexion in the akylosed knee. Orthopaedics 8: 45–48Google Scholar
  47. Thompson TC (1944) Quadricepsplasty to improve knee function. J Bone Joint Surg (Am) 26: 366Google Scholar
  48. Thornhill T, Maguire J, (1987) Infected total knee arthroplasty. In: Scott WN, (ed) Total knee revision arthroplasty, Grune and Stratton, Orlando, Fla,. pp 79–88Google Scholar
  49. Uchida S, Yoshino S, Doi M, Kudo H, (1980) Side-effects of prosthetic materials on the human body. Int Orthop 3: 258–291CrossRefGoogle Scholar
  50. Wade PJF, Duhan RA, (1984) Arthrodesis of the knee after failed knee replacement. J Bone Joint Surg (Br) 66: 362–366PubMedGoogle Scholar
  51. Wilde A, Ruth J, (1988) Two stage reimplantation in total knee arthroplasty. Clin Orthop 236: 23–35PubMedGoogle Scholar
  52. Wolff AM, Hungerford DS, Krackow KA, Jacobs MA, (1989) Osteotomy of the tibial tubercle during total knee replacement. A report of twenty-six cases. J Bone Joint Surg (Am) 71: 848–852PubMedGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1991

Authors and Affiliations

  • Edward T. Habermann

There are no affiliations available

Personalised recommendations