Septic complications of knee replacements and their treatment

The introduction of the modern total knee replacement has been revolutionary in treatment of degenerative joint disease. Over recent years there has been a significant increase in the number of primary replacements and revision procedures. Prosthetic joint infection is an important and devastating complication which has not been eliminated by modern day practice. Patient selection, operating environment, surgical technique and soft tissue management can reduce but not eliminate the incidence of infection. When infection occurs, it should be managed as part of a multidisciplinary team to ensure an optimal outcome. Revision for infection can be performed as a single-stage or two-stage procedure. When revision surgery fails, salvage options should be considered including: salvage arthroplasty, arthrodesis, resection arthroplasty and amputation. The challenges for the surgeon to overcome include: a poor soft tissue envelope, ligamentous or extensor mechanism disruption and bone loss. Complications are not uncommon with salvage options and therefore meticulous preoperative planning and a thorough consent process are mandatory. The management of patients with an infected implant should performed by consultants who have specialized expertise and who work in networks. This is necessary to achieve the best results. This article will also discuss the salvage options.