Treatment of the Infected Total Knee

Infection after total knee arthroplasty is a devastating complication with multiple treatment options. Irrigation and debridement with a polyethylene liner exchange can be used for knees with an acute postoperative or acute hematogenous infection; however, the literature suggests a failure rate of approximately 50%, with some larger and more recent series suggesting success rates that are even lower. For a chronically infected total knee arthroplasty, options include a 1-stage or a 2-stage exchange with pros and cons to both approaches; however, a thorough debridement is key for both techniques. Resection arthroplasty, fusion, and above-the-knee amputation are options for patients with recurrent infection and/or who are not candidates for further attempts at knee reconstruction. Finally, other adjunct treatments, including chronic antibiotic suppression and multiple methods of antibiotic delivery, are described.