Team Approach: The Management of Infection After Total Knee Replacement

Abstract

Diagnosis and management of infection after total knee arthroplasty are challenging. They require a multidisciplinary team approach, much like the management of musculoskeletal tumors. Patients presenting with suspected infection after total knee arthroplasty require diagnostic confirmation, medical optimization, comprehensive surgical care that may include measures to cover the soft tissues, administration of long-term antibiotics, and extended rehabilitation to improve outcome. Surgeons should work closely with infectious disease specialists or microbiologists at every step to minimize the perioperative risks of reinfection, should decide on the most appropriate surgical modality and antibiotic regime, and should monitor the response to therapy. The current evidence on the best surgical management of infection after total knee arthroplasty (debridement and retention of prostheses compared with 1-stage exchange or 2-stage exchange arthroplasty) is lacking. Randomized, prospective studies that are under way may provide this much-needed information.