The Management and Outcome of Deep Infection in Total Knee Arthroplasty

A consecutive series of 36 patients (17 men and 19 women, 38 knees) were treated for infection following total knee arthroplasty (TKA) in our hospital. The average age at operation was 63.5 years (range, 38-76 years) and the average follow-up period was 2.94 years (range, 2-5.5 years). Initially, 16 knees were treated with debridement and antibiotics, while 22 knees had removal of prosthesis. Debridement failed in 9 knees and prosthesis was removed. Seven retained prosthesis after debridement only 2 of them had satisfactory results without recurrence of infection. Revision arthroplasty was performed on 21 knees, and 7 knees failed in this group. Twelve knees with removal of the prosthesis had an arthrodesis; 6 underwent one-stage arthrodesis by means of Hoffman external fixation and two failed. The remaining 6 arthrodesis were performed as a two-stage operation with bone grafting, and solid fusion was accomplished. Above-knee amputation was executed over two patients due to uncontrollable infection. Therefore, vigorous debridement with antibiotic therapy is indicated in the management for the early infection after TKA. If debridement failed, removal of the prosthesis and two-stage reimplantation were recommended. In uncontrollable infection, two-stage arthrodesis with internal fixation might be considered.