Treatment based on the type of infected TKA improves infection control.
BACKGROUND
A classification system with four types of infected TKAs has been commonly used to determine treatment, especially with regard to whether the prosthesis should be removed or retained.


OBJECTIVE
We asked whether (1) the classification-dictated treatment of the four types of infection after TKA would control infection and maintain functional TKA; (2) repeated débridement and two-stage TKA would further improve the infection control rate after initial treatment; and (3) fixation of TKA prosthesis to the host bone was achieved.


METHODS
We retrospectively reviewed 114 patients with 116 infected TKAs. We determined the infection control rate after initial treatment, repeated débridement and two-stage TKA. We evaluated the functional and radiographic results using the Knee Society and Hospital for Special Surgery knee scoring systems. The minimum followup was 2 years (mean, 5.6 years; range, 2-8 years).


RESULTS
The overall infection control rate was 100% in all patients. All patients with early superficial postoperative infection, 94% of patients with early deep postoperative infection, 96% of patients with late chronic infection, and 86% of patients with acute hematogenous infection maintained functioning knee prosthesis at the final followup. One hundred nine of the 114 patients could walk with no or only slight pain and maintained functioning knee prostheses. These 109 patients had stable fixation of the TKA prosthesis to host bone.


CONCLUSIONS
The techniques proposed by the classification effectively controlled infection and maintained functional TKA with firm fixation of the TKA prosthesis in most patients. Repeated débridement and two-stage TKA further improved the control of infection and functional TKA after initial treatment.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Kim
Young-Hoo
YH
The Joint Replacement Center of Korea, Ewha Womans University School of Medicine, MokDong Hospital, 911-1 Mokdong, YangChun-Gu, Seoul 158-710, Korea. younghookim@ewha.ac.kr
Choi
Yoowang
Y
Kim
Jun-Shik
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007720:Knee Prosthesis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000145:classification / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D011859:Radiography; D012086:Reoperation; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents