Treatment of the Infected Total Knee Arthroplasty

  • Russell E. Windsor


Infection after total knee arthroplasty represents perhaps the worst complication of this operation that a surgeon must treat. Only through identification of various risk factors and development of prophylactic regimens has the incidence of infection decreased. Successful treatment depends on a team approach, with cooperation of an orthopaedic surgeon, plastic surgeon, and an infectious disease specialist.


Total Knee Arthroplasty Knee Replacement Total Knee Replacement Resection Arthroplasty Wound Drainage 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Deburge A, GUEPAR Group: Guepar hinge prosthesis: Complications and results with two years’follow-up. Clin Orthop 1976, 120:47-53.PubMedGoogle Scholar
  2. 2.
    Grogan TJ, Dorey F, Rollins J, et al: Deep sepsis following total knee arthroplasty: Ten-year experience at the University of California at Los Angeles Medical Center. J Bone Joint Surg; 68A:226-234, 1986.PubMedGoogle Scholar
  3. 3.
    Rand JA, Bryan RS: Reimplantation for salvage of an infected total knee arthroplasty. J Bone Joint Surg; 65-A: 1081-1086, 1983.Google Scholar
  4. 4.
    Schoifet SD, Money BF: Treatment of infection after total knee arthroplasty by debridement with retention of the components. J Bone Joint Surg; 72A:1383-1390, 1990.PubMedGoogle Scholar
  5. 5.
    Wilson MG, Kelley K, Thornhill TS: Infection as a complication of total knee-replacement arthroplasty: Risk factors and treatment in sixty-seven cases. J Bone Joint Surg; 72A: 878-883, 1990.PubMedGoogle Scholar
  6. 6.
    Rand JA, Bryan RS, Money BF, et al: Management of infected total knee arthroplasty. Clin Orthop 1986, 205:75-85.PubMedGoogle Scholar
  7. 7.
    Garner RW, Mowat AG, Hazlemena BL: Wound healing after operations on patients with rheumatoid arthritis. J Bone Joint Surg; 55-B: 55:134-144, 1973.Google Scholar
  8. 8.
    Thomas BJ, Moreland JR, Amstutz HC: Infection after total joint arthroplasty from distal extremity sepsis. Clin Orthop 1983, 181:121-125.PubMedGoogle Scholar
  9. 9.
    Wilson MG, Kelley, K, Thornhill,RS. Infection as a complication of total knee replacement arthroplasty. Risk Factors and treatment in sixty seven cases. J. Bone Joint Surg. 72-A:878-883, 1990.Google Scholar
  10. 10.
    Lindqvist C, Slatis P: Dental bacteremia: A neglected cause of arthroplasty infections: three hip cases. Acta Orthop Scand 1985, 56:506-508.PubMedCrossRefGoogle Scholar
  11. 11.
    Nelson JP, Fitzgerald RH Jr, Jaspers MT, et al: Prophylactic antimicrobial coverage in arthroplasty patients (editorial). J Bone Joint Surg; 72-A, 1, 1990.PubMedGoogle Scholar
  12. 12.
    Ainscow DAP, Denham RA: The risk of hematogenous infection in total joint replacements. J Bone Joint Surg; 66-B: 580-582, 1984.Google Scholar
  13. 13.
    England SP, Stern SH, Insall JN, et al: Total knee arthroplasty in diabetes mellitus. Clin Orthop 1990; 260:130-134.PubMedGoogle Scholar
  14. 14.
    Rae T: A study on the effects of particulate metals of orthopaedic interest on murine macrophages in vitro. J Bone Joint Surg; 57-B:444-450, 1975.Google Scholar
  15. 15.
    Schurman DJ, Johnson BL Jr, Amstutz HC: Knee joint infections with Staphylococcus aureus and Micrococcus species: Influence of antibiotics, metal debris, bacteremia, blood, and steroids in a rabbit model. J Bone Joint Surg; 57A: 40-49, 1975.PubMedGoogle Scholar
  16. 16.
    Windsor RE, Insall JN, Urs, WK, et al: Two-stage reim-plantation for the salvage of total knee arthroplasty complicated by infection: Further follow-up and refinement of indications. J Bone Joint Surg; 72-A:272-278, 1990.PubMedGoogle Scholar
  17. 17.
    Borden LS, Gearen PF: Infected total knee arthroplasty: A protocol for management. J Arthroplasty 1987;2:27-36.PubMedCrossRefGoogle Scholar
  18. 18.
    Insall JN, Thompson FM, Brause BD: Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg; 655-A:1087-1098, 1983.Google Scholar
  19. 19.
    Lonner JH, Desai P, Di Cesare PE, Steiner G, Zuckerman JD. The reliability of analysis of intraoperative frozen sec-fions for identifying active infection during revision hip or knee arthroplasty. J. Bone Joint Surg; 78-A:1553-1558, 1996.PubMedGoogle Scholar
  20. 20.
    Feldman DS, Lonner JH, Desai P, Zuckerman JD. The role of intraoperattive frozen sections in revision total joint arthrtoplasty. J. Bone Joint Surg; 77-A:1807-1813, 1995.PubMedGoogle Scholar
  21. 21.
    Rand, JA. Instructionasl Course Lectures. The American Academy of Orthopaedic Surgeons. Alternatives to reim-plantation for salvage f the total knee arthroplasty complicated by infection. J. Bone Joint Surg; 75-A:282-289, 1993.PubMedGoogle Scholar
  22. 22.
    Johnson DP, Bannister GC: The outcome of infected arthroplasty of the knee. J Bone Joint Surg; 68-B:289-291, 1986.Google Scholar
  23. 23.
    Marsh PK, Cotler JM: Management of an anaerobic infection in a prosthetic knee with long-term antibiotics alone: A case report. Clin Orthop 1981;155:133-135.PubMedGoogle Scholar
  24. 24.
    Woods GW, Lionberger DR, Tullos HS: Failed total knee arthroplasty: Revision and arthrodesis for infection and noninfectious complications. Clin Orthop 1983;173:184-190.PubMedGoogle Scholar
  25. 25.
    Peled IJ, Frankl U, Wexler MR: Salvage of exposed knee prosthesis by gastrocnemius myocutaneous flap coverage. Orthopedics 1983; 6:1320-1322.Google Scholar
  26. 26.
    Sanders R, O’Neill T: The gastrocnemius myocutaneous flap used as a cover for the exposed knee prosthesis. JU Bone Joint Surg; 63-B:383-386, 1981.Google Scholar
  27. 27.
    Falahee MH, Matthews LS, Kaufer H: Resection arthroplasty as a salvage procedure for a knee with infection after a total arthroplasty. J Bone Joint Surg; 69-A:1013-1021, 1987.PubMedGoogle Scholar
  28. 28.
    Lettin AWF, Neil MJ, Citron ND, et al: Excision arthroplasty for infected constrained total knee replacements. J Bone Joint Surg; 72-B:220-224, 1990.Google Scholar
  29. 29.
    Hagemann WF, Woods GW, Tullos HS: Arthrodesis in failed total knee replacement. J Bone Joint Surg; 60-A:790-794, 1979.Google Scholar
  30. 30.
    Puranen J, Kortelainen P, Jalovaara P: Arthrodesis of the knee with intra-medullary nail fixation. J Bone Joint Surg; 72-A:433-442, 1990.PubMedGoogle Scholar
  31. 31.
    Rosenberg AG, Haas B, Barden R, et al: Salvage of infected total knee arthroplasty. Clin Orthop 1988; 226:29-33.PubMedGoogle Scholar
  32. 32.
    Whiteside LA. Treatment of Infected Total Knee Arthroplasty. Clin Orthop 1994; 299:169-172.PubMedGoogle Scholar
  33. 33.
    Pring DJ, Marks L, Angel JC: Mobility after amputation for failed knee replacement. J Bone Joint Surg; 70-B: 770-771, 1988.Google Scholar
  34. 34.
    Isiklar ZU, Landon GC, Tullos HS: Amputation after Failed total knee Arthroplasty. Clin Orthop 1994; 299:173-178.PubMedGoogle Scholar
  35. 35.
    Adam RF, Watson SB, Jarratt JW, Noble J, Watson JS. Outcome after Flap Cover for Exposed Total Knee Arthroplasties. A report of 25 cases. J. Bone Joint Surg; 76-B:750-753, 1994.Google Scholar
  36. 36.
    Burger RR, Basch T, Hopson CN: Implant Salvage in Infected total knee arthroplasty. Clin Orthop: 1991; 273: 105-112.PubMedGoogle Scholar
  37. 37.
    Lettin AWF, NEIL MJ, Citron ND. Excision Arthroplasty for Infected Constrained Total Knee Replacements. J. Bone Joint Surg; 72-B:220-224, 1990.Google Scholar
  38. 38.
    Ellingsen, DE and Rand JA. Intramedullary arthrodesis of the knee after failed total knee arthroplasty. J. Bone Joint Surg; 76-A:870-877, 1994.Google Scholar
  39. 39.
    Wilde AH, Ruth JT: Two Stage Reimplantation in infected total knee arthroplasty. Clin Orthop 1988; 236:23-35.PubMedGoogle Scholar
  40. 40.
    Trippel SB. Current Concepts Revirew. Antibiotic-im pregnated cement in total joint arthroplasty. J. Bone Joint Surg; 68-A:1297-1302. 1986.PubMedGoogle Scholar
  41. 41.
    James PJ, Butcher IA, Gardner ER, Hamblin DL: Methicillin-Resistant StaphylococcusEpidermidis in Infection of Hip Arthoplasties. J. Bone Joint Surg. 76-B:725-727, 1994.Google Scholar
  42. 42.
    Carlsson AS, Josefsson G, Lindberg L: Revision with gentamycin-impregnated cement for deep infections in total hip arthroplasties. J Bone Joint Surg; 60-A:1059-1064, 1978.PubMedGoogle Scholar
  43. 43.
    Freeman MAR, Sudlow RA, Casewell MW et al: The management of infected total knee replacements. J Bone Joint Surg; 67-B:764-768, 1985.Google Scholar
  44. 44.
    Marks KE, Nelson CL, Lautenschlager EP: Antibiotic-impregnated acrylic bone cement. J Bone Joint Surg; 58A:358-364, 1976.PubMedGoogle Scholar
  45. 45.
    Hanssen AD, Rand JA, Osmon DR: Treatment of the infected total knee arthroplasty with insertion of another prosthesis. The effect of antibiotic-impregnated cement. Clin Orthop 1994; 309:44-55.PubMedGoogle Scholar
  46. 46.
    Goksan, SB & Freeman, MAR. One Stage Reimplantation for Infected Total Knee Replacement. J. Bone Joint Surg; 74-B:78-82, 1992.Google Scholar
  47. 47.
    Scott IR, Stockly I, Getty CJM. Exchange Arthroplasty for Infected knee Replacements. A New Two-Stage Method. J. Bone Joint Surg; 75-B:28-31, 1993.Google Scholar

Copyright information

© Springer-Verlag Wien 2001

Authors and Affiliations

  • Russell E. Windsor
    • 1
  1. 1.The Hospital for Special SurgeryNew York

Personalised recommendations