Advertisement

Diagnosis and Management of Infection Following Total Knee Arthroplasty

  • Barry D. Brause

Abstract

Prosthetic total knee arthroplasty has become commonplace, restoring full function to severely disabled individuals. However, infection of these prostheses, which occurs in 1–2% of patients, is a catastrophic event associated with protracted hospitalization, major financial expenditure, and renewed disability. The indwelling metallic prosthesis and the polymethylmethacrylate cement, which binds the metal alloy to adjacent bone, represent foreign bodies and predispose both joint space and bone to septic processes. Metallic foreign bodies contribute to local sepsis experimentally by decreasing the quantity of bacteria necessary to establish infection and by permitting pathogens to persist on the surface of the avascular material, sequestered from circulating immune factors (leukocytes, antibody, and complement) and systemic antibiotics [7]. The polymethylmethacrylate cement represents additional foreign material which has been shown to inhibit phagocytic and lymphocytic function in vitro [10,15–17].

Keywords

Total Knee Arthroplasty Bone Cement Total Knee Replacement Prosthetic Joint Infection Total Joint Replacement 
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. 1.
    Ahlberg A, Carlsson AS, Lindberg L:Hema-togenous infection in total joint replacement. Clin Orthop 137:69, 1978PubMedGoogle Scholar
  2. 2.
    Andrews HJ, Arden GP, Hart GM, Owen JW:Deep infection after total hip replacement. J Bone and Joint Surg 63-B:53, 1981Google Scholar
  3. 3.
    Buchholz HW, Elson R, Lodenkamper H:The infected joint implant. In McKibbin B (ed.):Recent Advances in Orthopaedics. Edinburgh, Churchill Livingstone, 1979, pp 139–161Google Scholar
  4. Buchholz HW, Elson RA, Engelbrecht E, Lodenkamper H, Rottger J, Siegel A:Manage-ment of deep infection of total hip replacement. J Bone and Joint Surg 63-B:342, 1981Google Scholar
  5. Carlsson AS, Josefsson G, Lindberg L:Revision with gentamicin-impregnated cement for deep infections in total hip arthroplasties. J Bone and Joint Surg 60-A:1059, 1978Google Scholar
  6. 6.
    Eftehar NS:Wound infection complicating total hip joint arthroplasty; Scope of the problem and its diagnosis. Orthop Rev 8:49, 1979Google Scholar
  7. 7.
    Elek SD, Conen PE:The virulence of Staph, pyogenesfor man; a study of problems of wound infection. Br J Exp Pathol 38:573, 1957PubMedGoogle Scholar
  8. 8.
    Elson RA, Jephcott AD, McGechie, DB, Verettas D:Antibiotic-loaded acrylic cement. J Bone Joint Surg 59B:200, 1977Google Scholar
  9. 9.
    Fitzgerald RH Jr, Nolan DR, Ilstrup DM, Van Scoy RE, Washington JA, Coventry MB:Deep wound sepsis following total hip arthroplasty. J Bone and Joint Surg 59A:847, 1977Google Scholar
  10. 10.
    Green SA:The effect of methylmethacrylate on phagocytosis, InProceedings of the Orthopedic Research Society. J Bone and Joint Surg 57A:583, 1975Google Scholar
  11. 11.
    Gristina AG, Kolkin J:Total joint replacement and sepsis. J Bone and Joint Surg 65A-:128, 1983Google Scholar
  12. 12.
    Hoff SF, Fitzgerald RH Jr, Kelly PJ:The depot administration of penicillin G and gentamicin in acrylic bone cement. J Bone Joint Surg 63A:798, 1981Google Scholar
  13. 13.
    Lattimer G, Keblish PA, Dickson TB, Vernick, CG, Finnegan WJ:Hematogenous infection in total joint replacement:Recommendations for prophylactic antibiotics. JAMA 242:2213, 1979PubMedCrossRefGoogle Scholar
  14. 14.
    Marks KE, Nelson, CL, Lautenschlarger EP:Antibiotic-impregnated acrylic bone cement. J Bone Joint Surg 58A.-358, 1976Google Scholar
  15. 15.
    Panush RS, Petty RW:Inhibition of human lymphocyte responses by methylmethacrylate. Clin Orthop 134:356, 1978PubMedGoogle Scholar
  16. 16.
    Petty W:The effect of methylmethacrylate on chemotaxis of polymorphonuclear leukocytes. J Bone and Joint Surg 60A:492, 1978Google Scholar
  17. 17.
    Petty W:The effect of methylmethacrylate on bacterial phagocytosis and killing by human polymorphonuclear leukocytes. J Bone and Joint Surg 60A:752, 1978Google Scholar
  18. Pichnell B, Mizen L, Sutherland R:Antibacterial activity of antibiotics in acrylic bone cement. J Bone Joint Surg 59-B:302, 1977Google Scholar
  19. 19.
    Salvati E, Insall, JN:The management of sepsis in total knee replacement. In Savastano A A (ed):Total Knee Replacement. New York, Appleton-Century-Crofts, 1980, pp 49 – 58Google Scholar
  20. 20.
    Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr:Reimplantation in infection. Clin Orthop 170:62, 1982PubMedGoogle Scholar
  21. 21.
    Turner, RH, Miley GD, Fremont-Smith P:Septic total hip replacement and revision arthroplasty. In Turner RH, Schiller AD (ed), Revision Total Hip Arthroplasty, New York, Grune and Stratton, 1982, pp 291 – 314Google Scholar
  22. 22.
    Wahlig H, Dingeldein E:Antibiotics and bone cements:experimental and clinical long-term observations. Acta orthop scand 51:49, 1980PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc 1985

Authors and Affiliations

  • Barry D. Brause

There are no affiliations available

Personalised recommendations