Elective Treatment Strategy for Knee Prosthetic Joint Infection

Introduction: Prosthetic joint infection (PJI) is a complication, rarely encountered in daily clinical practice, but its treatment is frequently unsuccessful. In this report, we describe the treatment strategy used at our hospital, which has provided stable therapeutic results.

Methods: We conducted a retrospective analysis of infections following knee arthroplasty at our hospital between April 2005 and December 2022.

Results: Post-total knee arthroplasty (TKA) infection occurred in 26 of 2132 patients (1.2%), and post-unicompartmental knee arthroplasty (UKA) infection occurred in six of 842 patients (0.7%); the difference was not significant (p=0.22). Infection occurred ≤3 months postoperatively in 13 patients with TKA and three with UKA, and ≥4 months postoperatively in 13 patients with TKA and three with UKA. Recurrent infection was observed in five patients with TKA and no patients with UKA. We did not conduct surgery for patients with PJI until causative bacteria were identified. We performed debridement, antibiotics, and implant retention (DAIR), with debridement of the synovium and insert replacement. Irrigation or drain placement was not conducted. The appropriate antibiotic was administered at a sufficient dose for a sufficiently long period, and the transfer of antibiotics into the bone marrow was not considered. Although some cases of recurrence were noted, treatment was successful in all cases, with no instances of obvious implant loosening or medullary lesions.

Conclusions: In the absence of implant loosening, the post-arthroplasty infection can be controlled by elective debridement surgery and selective administration of the optimal antibiotic.