Infection in total knee arthroplasty

Abstract

The specter of deep infection continues to temper the optimism regarding total knee arthroplasty (TKA), despite an incidence of less than 1% to 2%.1-3 Infection after TKA is a topic of interest because of its diagnostic challenges, requisite intensity of care, and compromised outcomes. Efforts at reducing the rate of infection have allowed the identification of significant risk factors and the establishment of protocols for prevention.4,5 Substantial progress has been made in the approach toward the diagnosis and treatment of the infected TKA.6 The primary goal of treatment in most patients with an infected TKA is the eradication of the infecting pathogen. Efforts aimed at achieving this goal should ideally result in a painless and functional extremity; however, function is occasionally sacrificed to clear the infection. The cost of treating the infected TKA can be a burden for the patient, surgeon, hospital, and society. Hebert et al.7 reported on the cost of caring for infected TKA in New Orleans between 1990 and 1993. Infected TKAs required 3 to 4 times the hospital resources when compared with primary TKAs, and double the resources when compared with aseptic revision TKAs. The net financial loss to the hospital was $15000 per patient, with an average loss of $30000 for Medicare patients. Sculco estimated the average annual cost of managing infected joint arthroplasties in the United States is $150 to $200 million.8 This chapter reviews the currently available options for the diagnosis and management of infected TKAs. © 2005 Springer Science+Business Media, Inc. All rights reserved.