Successful two-stage primary total knee arthroplasty for infective arthritis of the knee – our experience

Abstract

Background: The incidence of septic arthritis is 2e10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection. Patients and methods: Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation. Discussion: With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same. Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2 nd stage reducing hospital stay, morbidity, and cost. Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection. Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information. Conclusion: All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.

Outcomes of Primary Total Knee Arthroplasty Following Septic Arthritis of the Native Knee

“…While the literature has primarily focused on developing treatment modalities to improve the outcomes of TKA following native knee septic arthritis, the contemporary literature has yet to define the magnitude of risk that prior septic arthritis infections have on the outcome of TKA. Most studies, limited by sample size or lack of a control cohort, have suggested that the incidence of PJI following total joint arthroplasty is somewhere between 3% and 15% in patients with prior native joint septic arthritis, whereas the overall rate of PJI after TKA in U.S. hospital registries is approximately 1% 1,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] .…”

“…1), in some cases necessitating total knee arthroplasty (TKA) 3,4 .Previously reported rates of periprosthetic joint infection (PJI) after TKA in patients with previous septic arthritis of the native knee have ranged from 3% to 15%, whereas the overall rate of PJI following TKA is approximately 1% [5][6][7][8] . Most reports on septic arthritis of the native knee preceding TKA have been limited by small cohorts, have been systematic review-type articles, and/or have lacked reporting of survivorship compared with a control cohort 1,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Therefore, we sought to compare the outcomes of TKA in patients with a history of native knee septic arthritis and those in a matched control cohort of patients with primary osteoarthritis (OA) during the same time period.The primary purpose of the present study was to compare the outcomes of TKA in patients with a history of native knee septic arthritis (with a specific focus on survivorship free of any infection, PJI, aseptic revision, any revision, and any reoperation) with those in a matched cohort of patients with Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G605).…”

“…Previously reported rates of periprosthetic joint infection (PJI) after TKA in patients with previous septic arthritis of the native knee have ranged from 3% to 15%, whereas the overall rate of PJI following TKA is approximately 1% [5][6][7][8] . Most reports on septic arthritis of the native knee preceding TKA have been limited by small cohorts, have been systematic review-type articles, and/or have lacked reporting of survivorship compared with a control cohort 1,[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Therefore, we sought to compare the outcomes of TKA in patients with a history of native knee septic arthritis and those in a matched control cohort of patients with primary osteoarthritis (OA) during the same time period.…”

Two-stage Total Knee Arthroplasty in the Treatment of Advanced Knee Septic Arthritis: A Single-center Experience

“…Previous studies were mostly case reports 3,[11][12][13] , and evidences regarding the therapy aspect was limited.…”