Trends in the treatment of infected knee arthroplasty

Overview

This 2020 instructional lecture in EFORT Open Reviews by Tözün, Ozden, Dikmen and Karaytuğ reviews current approaches to periprosthetic joint infection after total knee arthroplasty, one of the most challenging complications of knee replacement.

Who it is for

Knee arthroplasty and revision surgeons, infectious disease specialists, microbiologists and orthopaedic residents managing infected knee replacements.

Key areas covered

The lecture sets out the classification of knee PJI by timing (acute-early, delayed-chronic, late-haematogenous acute and late-chronic) and links it to the assumed maturity of biofilm on the implant. It refers to the evidence-based scoring system for defining PJI proposed at the 2018 International Consensus Meeting. It then reviews the main surgical strategies: debridement, antibiotics and implant retention (DAIR); one-stage exchange; two-stage exchange; and salvage procedures when these fail.

Notable emphasis

The authors stress that aggressive debridement, removing all avascular tissue and biofilm-bearing foreign material, is essential whichever strategy is chosen. They describe DAIR as a reasonable first procedure for selected acute infections with a well-fixed, functioning implant, and outline the patient profile suited to one-stage exchange. For two-stage exchange, they note that no validated biomarkers define the right moment for re-implantation, and that antibiotic-free intervals and routine aspiration before the second stage are no longer recommended.

How to use this guideline

The article gives a practical framework for selecting a surgical strategy. Readers should consult the full text for the detailed selection criteria and treatment algorithm.