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J Knee Surg 2021; 34(13): 1388-1395
DOI: 10.1055/s-0041-1737030
DOI: 10.1055/s-0041-1737030
Special Focus Section
Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty
Abstract
Total knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.
Publication History
Received: 22 June 2021
Accepted: 22 July 2021
Article published online:
02 October 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
- 2 Springer BD, Scuderi GR. Evaluation and management of the infected total knee arthroplasty. Instr Course Lect 2013; 62: 349-361
- 3 Inabathula A, Dilley JE, Ziemba-Davis M. et al. Extended oral antibiotic prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate. J Bone Joint Surg Am 2018; 100 (24) 2103-2109
- 4 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
- 5 Parvizi J, Tan TL, Goswami K. et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018; 33 (05) 1309-1314.e2
- 6 Kim S-J, Cho YJ. Current guideline for diagnosis of periprosthetic joint infection: a review article. Hip Pelvis 2021; 33 (01) 11-17
- 7 Ting NT, Della Valle CJ. Diagnosis of periprosthetic joint infection-An algorithm-based approach. J Arthroplasty 2017; 32 (07) 2047-2050
- 8 Xiong L, Li S, Dai M. Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection. J Orthop Surg Res 2019; 14 (01) 240
- 9
De Maio F,
Fidone G,
Caterini A,
Gorgolini G,
Petrungaro L,
Farsetti P.
Monitoring of C-reactive protein level (CRP) and Erythrocyte sedimentation rate (ESR)
after total hip and knee arthroplasty. J Biol Regul Homeost Agents 2020; 34 (5, Suppl.
1) 63-68
MissingFormLabel
- 10 Park KK, Kim TK, Chang CB, Yoon SW, Park KU. Normative temporal values of CRP and ESR in unilateral and staged bilateral TKA. Clin Orthop Relat Res 2008; 466 (01) 179-188
- 11 Sukhonthamarn K, Tan TL, Xu C. et al. Determining diagnostic thresholds for acute postoperative periprosthetic joint infection. J Bone Joint Surg Am 2020; 102 (23) 2043-2048
- 12 Ghanem E, Parvizi J, Burnett RSJ. et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am 2008; 90 (08) 1637-1643
- 13 Shohat N, Goswami K, Fillingham Y. et al. Diagnosing periprosthetic joint infection in inflammatory arthritis: assumption is the enemy of true understanding. J Arthroplasty 2018; 33 (11) 3561-3566
- 14 Cipriano CA, Brown NM, Michael AM, Moric M, Sporer SM, Della Valle CJ. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am 2012; 94 (07) 594-600
- 15 Bedair H, Ting N, Jacovides C. et al. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res 2011; 469 (01) 34-40
- 16 Lee YS, Koo K-H, Kim HJ. et al. Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2017; 99 (24) 2077-2084
- 17 Deirmengian C, Kardos K, Kilmartin P. et al. The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip. Clin Orthop Relat Res 2015; 473 (01) 198-203
- 18 Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011; 93 (24) 2242-2248
- 19 Wang C, Li R, Wang Q, Wang C. Synovial fluid leukocyte esterase in the diagnosis of peri-prosthetic joint infection: a systematic review and meta-analysis. Surg Infect (Larchmt) 2018; 19 (03) 245-253
- 20 Chen Y, Kang X, Tao J, Zhang Y, Ying C, Lin W. Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis. J Orthop Surg Res 2019; 14 (01) 453
- 21 Zywiel MG, Stroh DA, Johnson AJ, Marker DR, Mont MA. Gram stains have limited application in the diagnosis of infected total knee arthroplasty. Int J Infect Dis 2011; 15 (10) e702-e705
- 22 Cancienne JM, Granadillo VA, Patel KJ, Werner BC, Browne JA. Risk factors for repeat debridement, spacer retention, amputation, arthrodesis, and mortality after removal of an infected total knee arthroplasty with spacer placement. J Arthroplasty 2018; 33 (02) 515-520
- 23 Manrique J, Komnos GA, Tan TL, Sedgh S, Shohat N, Parvizi J. Outcomes of superficial and deep irrigation and debridement in total hip and knee arthroplasty. J Arthroplasty 2019; 34 (07) 1452-1457
- 24 Iza K, Foruria X, Moreta J. et al. DAIR (Debridement, Antibiotics and Implant Retention) less effective in hematogenous total knee arthroplasty infections. J Orthop Surg Res 2019; 14 (01) 278
- 25 Wouthuyzen-Bakker M, Sebillotte M, Huotari K. et al; ESCMID Study Group for Implant-Associated Infections (ESGIAI). Lower success rate of débridement and implant retention in late acute versus early acute periprosthetic joint infection caused by Staphylococcus spp. Results from a matched cohort study. Clin Orthop Relat Res 2020; 478 (06) 1348-1355
- 26 Zhu MF, Kim K, Cavadino A, Coleman B, Munro JT, Young SW. Success rates of debridement, antibiotics, and implant retention in 230 infected total knee arthroplasties: implications for classification of periprosthetic joint infection. J Arthroplasty 2021; 36 (01) 305-310.e1
- 27 Bradbury T, Fehring TK, Taunton M. et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty 2009; 24 (6, Suppl) 101-104
- 28 Kim JG, Bae JH, Lee SY, Cho WT, Lim HC. The parameters affecting the success of irrigation and debridement with component retention in the treatment of acutely infected total knee arthroplasty. Clin Orthop Surg 2015; 7 (01) 69-76
- 29 Raszka D, Popelka Ml S, HeŘt J, NyČ O, Landor I, Jahoda D. [Revision of infected total knee arthroplasties with DAIR method - Factors affecting the two-year survival rate]. Acta Chir Orthop Traumatol Cech 2020; 87 (03) 175-182
- 30 Rajgopal A, Panda I, Rao A, Dahiya V, Gupta H. Does prior failed debridement compromise the outcome of subsequent two-stage revision done for periprosthetic joint infection following total knee arthroplasty?. J Arthroplasty 2018; 33 (08) 2588-2594
- 31 Zielinski MR, Ziemba-Davis M, Warth LC, Keyes BJ, Meneghini RM. Do antibiotic intramedullary dowels assist in eradicating infection in two-stage resection for septic total knee arthroplasty?. J Arthroplasty 2019; 34 (10) 2461-2465
- 32 Di Benedetto P, Di Benedetto ED, Buttironi MM. et al. Two-stage revision after total knee arthroplasty. Acta Biomed 2017; 88 (2S): 92-97
- 33 Czuban M, Wulsten D, Wang L, Di Luca M, Trampuz A. Release of different amphotericin B formulations from PMMA bone cements and their activity against Candida biofilm. Colloids Surf B Biointerfaces 2019; 183: 110406
- 34 Houdek MT, Greenwood-Quaintance KE, Morrey ME, Patel R, Hanssen AD. Elution of high dose amphotericin B deoxycholate from polymethylmethacrylate. J Arthroplasty 2015; 30 (12) 2308-2310
- 35 Silverberg D, Kodali P, Dipersio J, Acus R, Askew M. In vitro analysis of antifungal impregnated polymethylmethacrylate bone cement. Clin Orthop Relat Res 2002; (403) 228-231
- 36 Nahhas CR, Chalmers PN, Parvizi J. et al. A randomized trial of static and articulating spacers for the treatment of infection following total knee arthroplasty. J Bone Joint Surg Am 2020; 102 (09) 778-787
- 37 Voleti PB, Baldwin KD, Lee G-C. Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review. J Bone Joint Surg Am 2013; 95 (17) 1594-1599
- 38 Klemt C, Tirumala V, Oganesyan R, Xiong L, van den Kieboom J, Kwon Y-M. Single-stage revision of the infected total knee arthroplasty is associated with improved functional outcomes: a propensity score-matched cohort study. J Arthroplasty 2021; 36 (01) 298-304
- 39 Vecchini E, Micheloni GM, Perusi F. et al. Antibiotic-loaded spacer for two-stage revision of infected total knee arthroplasty. J Knee Surg 2017; 30 (03) 231-237
- 40 Hsu C-S, Hsu C-C, Wang J-W, Lin P-C. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J 2008; 31 (06) 583-591
- 41 McPherson EJ, Patzakis MJ, Gross JE, Holtom PD, Song M, Dorr LD. Infected total knee arthroplasty. Two-stage reimplantation with a gastrocnemius rotational flap. Clin Orthop Relat Res 1997; (341) 73-81
- 42 Stambough JB, Curtin BM, Odum SM, Cross MB, Martin JR, Fehring TK. Does change in ESR and CRP guide the timing of two-stage arthroplasty reimplantation?. Clin Orthop Relat Res 2019; 477 (02) 364-371
- 43 Kusuma SK, Ward J, Jacofsky M, Sporer SM, Della Valle CJ. What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee?. Clin Orthop Relat Res 2011; 469 (04) 1002-1008
- 44 Hardcastle JM, So DH, Lee G-C. The fate of revision total knee arthroplasty with preoperative abnormalities in either sedimentation rate or C-reactive protein. J Arthroplasty 2016; 31 (12) 2831-2834
- 45 George J, Kwiecien G, Klika AK. et al. Are frozen sections and MSIS criteria reliable at the time of reimplantation of two-stage revision arthroplasty?. Clin Orthop Relat Res 2016; 474 (07) 1619-1626
- 46 Xu C, Kuo F-C, Kheir M, Li X, Chai W, Chen J-Y. Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis. BMC Musculoskelet Disord 2019; 20 (01) 272
- 47 Lee YS, Fernando N, Koo K-H, Kim HJ, Vahedi H, Chen AF. What markers best guide the timing of reimplantation in two-stage exchange arthroplasty for PJI? A systematic review and meta-analysis. Clin Orthop Relat Res 2018; 476 (10) 1972-1983
- 48 Mortazavi SMJ, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res 2011; 469 (11) 3049-3054
- 49 Vielgut I, Schwantzer G, Leithner A, Sadoghi P, Berzins U, Glehr M. Successful two-stage exchange arthroplasty for periprosthetic infection following total knee arthroplasty: the impact of timing on eradication of infection. Int J Med Sci 2021; 18 (04) 1000-1006
- 50 Parry JA, Karau MJ, Kakar S, Hanssen AD, Patel R, Abdel MP. Disclosing agents for the intraoperative identification of biofilms on orthopedic implants. J Arthroplasty 2017; 32 (08) 2501-2504
- 51 Shaw JD, Miller S, Plourde A, Shaw DL, Wustrack R, Hansen EN. Methylene blue-guided debridement as an intraoperative adjunct for the surgical treatment of periprosthetic joint infection. J Arthroplasty 2017; 32 (12) 3718-3723
- 52 Hart A, Hernandez NM, Abdel MP, Mabry TM, Hanssen AD, Perry KI. Povidone-iodine wound lavage to prevent infection after revision total hip and knee arthroplasty: an analysis of 2,884 cases. J Bone Joint Surg Am 2019; 101 (13) 1151-1159
- 53 Hernandez NM, Hart A, Taunton MJ. et al. Use of povidone-iodine irrigation prior to wound closure in primary total hip and knee arthroplasty: an analysis of 11,738 cases. J Bone Joint Surg Am 2019; 101 (13) 1144-1150
- 54 Calkins TE, Culvern C, Nam D. et al. Dilute betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty: a randomized controlled trial. J Arthroplasty 2020; 35 (02) 538-543.e1
- 55 Ruder JA, Springer BD. Treatment of periprosthetic joint infection using antimicrobials: dilute povidone-iodine lavage. J Bone Jt Infect 2017; 2 (01) 10-14
- 56 Iorio R, Yu S, Anoushiravani AA. et al. Vancomycin powder and dilute povidone-iodine lavage for infection prophylaxis in high-risk total joint arthroplasty. J Arthroplasty 2020; 35 (07) 1933-1936
- 57 Buchalter DB, Kirby DJ, Teo GM, Iorio R, Aggarwal VK, Long WJ. Topical vancomycin powder and dilute povidone-iodine lavage reduce the rate of early periprosthetic joint infection after primary total knee arthroplasty. J Arthroplasty 2021; 36 (01) 286-290.e1
- 58 Riesgo AM, Park BK, Herrero CP, Yu S, Schwarzkopf R, Iorio R. Vancomycin povidone-iodine protocol improves survivorship of periprosthetic joint infection treated with irrigation and debridement. J Arthroplasty 2018; 33 (03) 847-850
- 59 O'Donnell JA, Wu M, Cochrane NH. et al. Efficacy of common antiseptic solutions against clinically relevant microorganisms in biofilm. Bone Joint J 2021; 103-B (05) 908-915
- 60 Schmidt K, Estes C, McLaren A, Spangehl MJ. Chlorhexidine antiseptic irrigation eradicates staphylococcus epidermidis from biofilm: an in vitro study. Clin Orthop Relat Res 2018; 476 (03) 648-653
- 61 Parsons M. CORR Insights: chlorhexidine antiseptic irrigation eradicates staphylococcus epidermidis from biofilm: an in vitro study. Clin Orthop Relat Res 2018; 476 (03) 654-655
- 62 Goswami K, Cho J, Foltz C. et al. Polymyxin and bacitracin in the irrigation solution provide no benefit for bacterial killing in vitro. J Bone Joint Surg Am 2019; 101 (18) 1689-1697
- 63 Presterl E, Suchomel M, Eder M. et al. Effects of alcohols, povidone-iodine and hydrogen peroxide on biofilms of Staphylococcus epidermidis. J Antimicrob Chemother 2007; 60 (02) 417-420
- 64 Lee G-C, Colen DL, Levin LS, Kovach III SJ. Microvascular free flap coverage for salvage of the infected total knee arthroplasty. Bone Joint J 2020; 102-B (6_Supple_A): 176-180
- 65 Siqueira MBP, Saleh A, Klika AK. et al. Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship. J Bone Joint Surg Am 2015; 97 (15) 1220-1232
- 66 Malahias M-A, Gu A, Harris EC. et al. The role of long-term antibiotic suppression in the management of peri-prosthetic joint infections treated with debridement, antibiotics, and implant retention: a systematic review. J Arthroplasty 2020; 35 (04) 1154-1160
- 67 Wouthuyzen-Bakker M, Nijman JM, Kampinga GA, van Assen S, Jutte PC. Efficacy of antibiotic suppressive therapy in patients with a prosthetic joint infection. J Bone Jt Infect 2017; 2 (02) 77-83
- 68 Renz N, Trampuz A, Zimmerli W. Controversy about the role of rifampin in biofilm infections: is it justified?. Antibiotics (Basel) 2021; 10 (02) 165
- 69 Zimmerli W, Sendi P. Role of rifampin against staphylococcal biofilm infections in vitro, in animal models, and in orthopedic-device-related infections. Antimicrob Agents Chemother 2019; 63 (02) e01746-18
- 70 Hernandez NM, Buchanan MW, Seyler TM, Wellman SS, Seidelman J, Jiranek WA. 1.5-stage exchange arthroplasty for total knee arthroplasty periprosthetic joint infections. J Arthroplasty 2021; 36 (03) 1114-1119
- 71 Petis SM, Perry KI, Pagnano MW, Berry DJ, Hanssen AD, Abdel MP. Retained antibiotic spacers after total hip and knee arthroplasty resections: high complication rates. J Arthroplasty 2017; 32 (11) 3510-3518
- 72 Watanabe K, Minowa T, Takeda S. et al. Outcomes of knee arthrodesis following infected total knee arthroplasty: a retrospective analysis of 8 cases. Mod Rheumatol 2014; 24 (02) 243-249
- 73 Balci HI, Saglam Y, Pehlivanoglu T, Sen C, Eralp L, Kocaoglu M. Knee arthrodesis in persistently infected total knee arthroplasty. J Knee Surg 2016; 29 (07) 580-588
- 74 Gathen M, Wimmer MD, Ploeger MM. et al. Comparison of two-stage revision arthroplasty and intramedullary arthrodesis in patients with failed infected knee arthroplasty. Arch Orthop Trauma Surg 2018; 138 (10) 1443-1452
- 75 Gathen M, Schmolders J, Wimmer MD. et al. [Modular arthrodesis system TITAN (KAM-TITAN) after failed revision total knee arthroplasty: operative technique and clinical experience]. Oper Orthop Traumatol 2020; 32 (01) 58-72
- 76 Wu CH, Gray CF, Lee G-C. Arthrodesis should be strongly considered after failed two-stage reimplantation TKA. Clin Orthop Relat Res 2014; 472 (11) 3295-3304
- 77 Son M-S, Lau E, Parvizi J, Mont MA, Bozic KJ, Kurtz S. What are the frequency, associated factors, and mortality of amputation and arthrodesis after a failed infected TKA?. Clin Orthop Relat Res 2017; 475 (12) 2905-2913
- 78 Hungerer S, Kiechle M, von Rüden C, Militz M, Beitzel K, Morgenstern M. Knee arthrodesis versus above-the-knee amputation after septic failure of revision total knee arthroplasty: comparison of functional outcome and complication rates. BMC Musculoskelet Disord 2017; 18 (01) 443
- 79 Fedorka CJ, Chen AF, McGarry WM, Parvizi J, Klatt BA. Functional ability after above-the-knee amputation for infected total knee arthroplasty. Clin Orthop Relat Res 2011; 469 (04) 1024-1032