The diagnosis and management of the infected total knee replacement

Infection after total knee replacement is a devastating and costly complication, both emotionally and financially. Reducing and treating infections effectively can lower the impact on the patient, the surgeon, and the health care system. Superficial infections are easily treated, but deep infections-about 0.5% to 2% of all arthroplasties-are difficult to eradicate, despite aggressive treatment protocols. Causes, infecting organisms, patient risk factors, and preventative measures are described. Making the correct diagnosis involves an accurate interpretation of laboratory data, aspiration, and radiographs and imaging studies. Although treatment options include antibiotic suppression, debridement with retention of the implant, arthrodesis, resection arthroplasty, and debridement with direct exchange implantation, the preferred option is delayed exchange implantation. Infection after reimplantation is discussed, and the author's surgical technique and treatment protocol are presented.