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Background: The treatment of knee arthritis with coexistent bone or joint sepsis is challenging. Despite the condition causing considerable morbidity, there is no generally agreed-upon approach to its treatment., Description of Technique: We used aggressive débridement of the knee and implantation of intraoperatively molded articulating antibiotic cement spacers with 4 g vancomycin and 2 g streptomycin per bag of cement for patients with unknown organisms as a first stage. When the infecting organism was known, organism-specific antibiotics were used. For fungal infections, 400 mg amphotericin B was added per bag of cement. This was followed by TKA as a second stage once soft tissues had healed 2 to 29 months later, (mean, 6 months) and return of laboratory parameters to within a normal range. One patient underwent two débridement and spacer procedures for suspected persistent infection., Methods: To determine whether this approach resulted in adequate control of infection and satisfactory scores for pain and function, we retrospectively reviewed 15 patients who presented with infected arthritic knees between 2001 and 2009; all patients with infected arthritic knees were treated with this same technique during this period. We assessed knee ROM, Knee Society scores, WOMAC scores, and VAS scores preoperatively and during followup. Followup was at a mean of 4 years (range, 2-7 years); No patient was lost to followup before 2 years., Results: Two of the 15 patients were comfortable with the spacers and declined a more definitive reconstruction, and no patient had a recurrent infection after TKA. Before spacer placement, the mean ROM was 103.° (range, 60°-150°), with the spacers in place it decreased to a mean 87° (range, 60°-135°), and after TKA it improved to a mean of 115° (range, 75°-150°). The mean Knee Society Knee and Function scores progressed from 41 and 43 preoperatively to 85 and 83 at latest followup, respectively. The WOMAC scores improved from 51 initially to 18 after TKA. The mean VAS scores improved from 66 preoperatively to 18 after the TKA., Conclusions: In this small proof-of-concept series, we found that joint débridement and use of intraoperatively molded articulating antibiotic cement spacers as part of a staged approach to treat the infected arthritic knee before TKA resulted in infection control in all patients at a minimum of 2 years' followup, reduction of knee pain, and restoration of knee function. We suggest that larger, comparative series be performed to further validate these results.

Unlabelled: Spinal infections are relatively uncommon but have potentially devastating consequences if not diagnosed and treated correctly. Compromised immunologic responsiveness, either transient or permanent, predisposes patients to more frequent and more severe infections. Through a Medline review of the English-language literature from 1990 to 2005, we examined the current understanding of the etiology of common immunocompromising conditions, how these diagnoses impact the relative spine infection rates including diagnosis and therapeutic monitoring, and practice trends regarding surgical intervention., Level of Evidence: Level V (expert opinion). Please see Guidelines for Authors for a complete description of the levels of evidence.

Although a relationship between diabetes and extremity infections has been established, the current literature notes little regarding the initial diagnosis of a patient's diabetic condition being made at the time of presentation with an extremity infection. The current study is an analysis of patients with extremity infections being diagnosed with diabetes for the first time. A chart review of 1166 patients who were admitted to the orthopaedic infection service revealed 385 patients with an admission glucose of 120 mg/dL or greater. One hundred seventy-four of these patients (45%) were diagnosed with diabetes. Thirty of these 174 patients (17.2%) previously had not been diagnosed with diabetes.