Abstract
Periprosthetic joint infection (PJI) is the most feared and challenging complication after total knee arthroplasty (TKA) due to the difficulty in diagnosis and treatment. The patient is exposed to multiple procedures, increasing the risk of complications, and finally compromising functional outcome. Currently, there is no gold standard test for PJI, and the final diagnosis is accomplished by combining clinical suspicion with inflammatory marker results. Two-stage exchange arthroplasty remains the preferred method of treatment for chronic PJI in TKA, with a high rate of success reported in literature. However, failures and complications in two-stage exchange can occur. There are no clarified guidelines to treat complications or treatment failures. Thus, each case should be individualized to offer options that match the patient’s expectations with what is achievable. The case report in this chapter represents the worst case scenario after a TKA, and is a reminder that the gold standard is far from perfect, while it outlines multiple instances a surgeon could encounter.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469:2992–4.
Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29:1331.
Della Valle C, Parvizi J, Bauer TW, et al. American Academy of Orthopedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am. 2011;93:1355–7.
Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91:38–47.
Dowsey MM, Choong PFM. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res. 2009;467:1577–81.
Schmidt RM, Rosenkranz HS. Antimicrobial activity of local anesthetics: lidocaine and procaine. J Infect Dis. 1970;121:597–607.
Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:1–10.
Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics. 2010;33:659.
Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT. Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop. 2009;80:67–77.
Mortazavi SMJ, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res. 2011;469:3049–54.
Munro JT, Garbuz DS, Masri BA, Duncan CP. Articulating antibiotic impregnated spacers in two-stage revision of infected total knee arthroplasty. J Bone Joint Surg Br. 2012;94:123–5.
Voleti PB, Baldwin KD, Lee G-C. Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review. J Bone Joint Surg Am. 2013;95:1594–9.
Struelens B, Claes S, Bellemans J. Spacer-related problems in two-stage revision knee arthroplasty. Acta Orthop Belg. 2013;79:422–6.
Gebauer M, Frommelt L, Achan P, et al. Management of fungal or atypical periprosthetic joint infections. J Arthroplasty. 2014;29:112–4.
Azzam K, McHale K, Austin M, Purtill JJ, Parvizi J. Outcome of a second two-stage reimplantation for periprosthetic knee infection. Clin Orthop Relat Res. 2009;467:1706–14.
Choi H-R, Freiberg AA, Malchau H, Rubash HE, Kwon Y-M. The fate of unplanned retention of prosthetic articulating spacers for infected total hip and total knee arthroplasty. J Arthroplasty. 2014;29:690–3.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Gomez, M.M., Manrique, J., Parvizi, J. (2015). Periprosthetic Infection: Management of Chronically Infected Total Knee Arthroplasty. In: Springer, B., Curtin, B. (eds) Complex Primary and Revision Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-18350-3_9
Download citation
DOI: https://doi.org/10.1007/978-3-319-18350-3_9
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-18349-7
Online ISBN: 978-3-319-18350-3
eBook Packages: MedicineMedicine (R0)