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. 2013 Nov 6;48(5):389-396.
doi: 10.1016/j.rboe.2013.01.003. eCollection 2013 Sep-Oct.

Infection after total knee replacement: diagnosis and treatment

Lúcio Honório de Carvalho Júnior  1 , Eduardo Frois Temponi  2 , Roger Badet  3
Affiliations

Infection after total knee replacement: diagnosis and treatment

Lúcio Honório de Carvalho Júnior et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Infection after total knee replacement (IATJ) is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases). Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

Infecção após artroplastia total do joelho (IATJ) é complicação incomum. Está associada a aumento da morbimortalidade e dos custos de internação. Cocos gram-positivos, sobretudo Staphylococcus coagulase-negative e Staphylococcus aureus, são os germes mais comumente isolados (> 50% de todos os casos). Condições ligadas ao paciente, ao procedimento cirúrgico e mesmo ao pós-operatório têm sido identificadas como fatores de risco para IATJ. Vários são os métodos complementares que se somam à investigação clínica para o diagnóstico infeccioso e melhor caracterização do quadro. O tratamento para a IATJ deve ser individualizado, mas geralmente envolve a combinação da antibioticoterapia sistêmica com o tratamento cirúrgico. A troca do implante em um ou dois estágios é o procedimento de escolha. Desbridamento com retenção da prótese é opção em casos agudos, com implantes estáveis e com germes sensíveis aos agentes antimicrobianos.

Keywords: Anti-bacterial agents; Arthroplasty, replacement, knee; Debridement; Infection.

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Figures

Fig. 1
Fig. 1
Stratification of the risk factors.
Fig. 2
Fig. 2
Algorithm for managing patients with a high likelihood of infection following TKA.
Fig. 3
Fig. 3
Algorithm for managing patients with a low likelihood of infection following TKA.
Fig. 4
Fig. 4
Algorithm for treating acute or subacute prosthetic infection.
Fig. 5
Fig. 5
Algorithm for treating infection that is not qualified for debridement + retention.
See this image and copyright information in PMC

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