Managing the infected knee - As good as it gets

The clinical presentation is a useful guide for selecting the treatment of an infected total knee arthroplasty. Prosthesis retention is indicated in patients with infections that occur within 30 days after arthroplasty and in patients with well-functioning prostheses who develop an acute late hematogenous infection. Debridement attempts should be open and not arthroscopic. When prosthesis removal is required, the preferred approach is a delayed reconstructive technique, the 2-staged reimplantation, rather than a direct-exchange procedure. The use of block spacers or mobile articulating devices to deliver high-dose local antibiotics is recommended between implant removal and delayed revision surgery. The use of antibiotic-loaded acrylic cement for cemented prostheses or antibiotic-soaked bone-graft with cementless prostheses is helpful in the overall cure rate of infection.