title: Management of the exposed total knee prosthesis, a six-year review.
abstract: BACKGROUND
  An exposed knee prosthesis is a limb threatening condition. Our unit manages such cases according to a multidisciplinary orthoplastic protocol. Whilst early prosthetic joint infection with dehiscence may be managed by Debridement, Antibiotics and Implant Retention (DAIR) and soft tissue coverage, the majority of these cases are chronic and in our unit are managed by Debridement, Explantation, Antibiotics (spacer and systemic) and Flap (DEAF).
  
  
  METHODS
  We report our experience of managing 17 of these challenging cases, 16 DEAFs and one DAIR and flap. Outcomes were assessed clinically and using the 36-item Short Form Health Survey (SF-36).
  
  
  RESULTS
  The mean time from arthroplasty to presentation in our unit was 19months (range: 0.5-80). Whilst an open knee replacement is by definition 'infected', significant microbiological growth from deep tissue/fluid samples was only detected in 14 patients (82%). Five patients (29.4%) subsequently underwent an amputation. Of these five, three patients were extensor deficient at presentation. At follow-up, health-related quality of life scoring using the Short Form-36 demonstrated poor physical function and highlighted differences in emotional function and pain levels between patients whose limbs were salvaged and patients who underwent amputation.
  
  
  CONCLUSIONS
  An exposed total knee prosthesis is a devastating complication, which despite our multidisciplinary salvage approach, has a high rate (5/17=29%) of amputation in this series. Quality of life in this patient group is poor irrespective of limb salvage. Salvage surgery was associated with worse pain, but better emotional profile than patients with an above knee amputation.
authors.affiliation: Department of Reconstructive Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom; Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom. Electronic address: katie.c.e.young@gmail.com.
authors.forename: Katie
authors.initials: K
authors.lastname: Young
authors.affiliation: Department of Reconstructive Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Shaheel
authors.initials: S
authors.lastname: Chummun
authors.affiliation: Department of Reconstructive Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wright
authors.affiliation: Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Darley
authors.affiliation: Department of Reconstructive Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Chapman
authors.affiliation: Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Porteous
authors.affiliation: Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: James R D
authors.initials: JR
authors.lastname: Murray
authors.affiliation: Department of Reconstructive Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Umraz
authors.initials: U
authors.lastname: Khan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents; D001168:Arthritis / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D002908:Chronic Disease; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects*; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Amputation; Arthroplasty; Exposed; Limb salvage; Patient reported outcomes; Reconstruction