Infection post-total knee replacement: current concepts

Abstract

Periprosthetic joint infection is a hot topic for investigation because it represents a challenging clinical problem with considerable burden for patients, institutions, and health systems. Despite our substantial knowledge, many details in prevention, pathophysiology, diagnosis, and treatment of infectious complications following total knee arthroplasty remain to be controversial with the available evidence being insufficient and at times conflictive. This manuscript is an attempt to approach the most recently published literature regarding the aforementioned details and aims to provide the reader with an updated perspective in the management of periprosthetic joint infection of the knee.

An implanted pH sensor read using radiography

“…[6][7][8] In the United States, approximately 5−10% of the 2 million fracture fixation surgeries performed annually progress to infection, which constitutes an enormous economic impact on patients, physicians and the healthcare system at large. [8][9][10][11][12] For instance, a study of the operative complications of ankle fractures found that both professional and technical expenses were substantially higher in patients presenting with infection, with median total charges of $128,122 compared to $49,983 for controls. 10 Similarly, in patients with periprosthetic joint infection (PJI), the mean annual cost was $116,383, compared to $28,249 for controls.…”

“…10 Similarly, in patients with periprosthetic joint infection (PJI), the mean annual cost was $116,383, compared to $28,249 for controls. 11,12 Furthermore, implant infection increases morbidity and mortality, reduces productivity, and decreases health-related quality of life. [8][9][10][11][12] While systemic antibiotics kill individual (planktonic) bacteria and alleviate symptoms, the bacteria colonizing implants can form densely pack communities of bacteria in extracellular polymer films (biofilms) which are highly resistant to antibiotics and form a nidus for infection once antibiotic therapy ceases.…”

“…11,12 Furthermore, implant infection increases morbidity and mortality, reduces productivity, and decreases health-related quality of life. [8][9][10][11][12] While systemic antibiotics kill individual (planktonic) bacteria and alleviate symptoms, the bacteria colonizing implants can form densely pack communities of bacteria in extracellular polymer films (biofilms) which are highly resistant to antibiotics and form a nidus for infection once antibiotic therapy ceases. 13,14 If bacterial colonization could be detected early, antibiotic treatment or surgical irrigation and debridement are often successful.…”

Acute arrest of hematopoiesis induced by infection with Staphylococcus epidermidis following total knee arthroplasty: A case report and literature review

“…Periprosthetic joint infection (PJI) is one of the most severe complications following TKA. This is a difficult issue for orthopaedic surgeons, as well as for patients and their families, due to its challenging management and the impact on the patients' quality of life (3,20).…”

Correlation between the Laboratory Test Results and Knee Functional Improvement of Pre- and Post-Total Knee Replacement Operation

“…Alijanipour and Parvizi studied inflammatory markers for diagnosing periprosthetic joint infection (PJI). Inflammatory markers included 1β, IL-4, IL-6, IL-17A, TNF (ELISA), CRP, ESR and WBC and were considered important factors [5]. 3) Chronic (more than 24 months).…”