Results of treatment of infection in both knees after bilateral total knee arthroplasty.
BACKGROUND
The purpose of this study was to review the results and complications of treatment of simultaneous infection of both knees after bilateral total knee arthroplasty.


METHODS
Between 1976 and 1999, twenty-one patients with a mean age of seventy-one years were treated for simultaneous infection of both knees after bilateral total knee arthroplasty. Two patients died within two years, and one patient was lost to follow-up after one year. The remaining eighteen patients were followed for a mean of five years. At the time of presentation, all twenty-one patients had had symptoms for less than three weeks. Eleven patients (twenty-two knees) were treated with attempts at prosthetic salvage with surgical débridement and administration of suppressive antibiotics. Resection arthroplasty was performed as the initial treatment in ten patients (twenty knees).


RESULTS
Of the ten patients treated with initial resection, seven patients (fourteen knees) underwent subsequent reimplantation. All fourteen knees were functioning well at the time of the latest follow-up, and none had been revised at a mean of two years after reimplantation. Of the eleven patients (twenty-two knees) who had been initially treated with prosthetic salvage, nine patients (eighteen knees) had a recurrence of the infection that required a reoperation (bilateral resection arthroplasty in seven patients, bilateral above-the-knee amputation in one patient, and repeat débridement of both knees in one patient). Two of the seven patients who had resection underwent reimplantation six weeks postoperatively, and the other five patients (ten knees) did not have reimplantation because of low functional demands and prohibitive medical comorbidity.


CONCLUSIONS
We believe that treatment of simultaneous infection of both knees after bilateral total knee arthroplasty should consist of bilateral resection arthroplasty and delayed reimplantation after a period of intravenous administration of organism-specific antibiotics.
Wolff
Luther H
LH
Mayo Clinic, Rochester, Minnesota 55905, USA.
Parvizi
Javad
J
Trousdale
Robert T
RT
Pagnano
Mark W
MW
Osmon
Douglas R
DR
Hanssen
Arlen D
AD
Haidukewych
George J
GJ
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome