Modern Treatment of Infected TKA With a 2-Stage Reimplantation Protocol

Geoffrey H. Westrich, MD,* Sarah Walcott-Sapp, BA,† Lindsey J. Bornstein, BA,† Mathias P. Bostrom, MD,* Russell E. Windsor, MD,* and Barry D. Brause, MD‡

* Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
† Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
‡ Department of Medicine, Hospital for Special Surgery, New York, New York

The Journal of Arthroplasty, Volume 25, Number 7 2010

Abstract:
The purpose of this study was to determine if 2-stage reimplantation for the treatment of infected total knee arthroplasty (TKA) is still effective for treating contemporary pathogens, many of which are multidrug resistant (MDR). The medical records of all cases of infected TKAs from April 1998 to March 2006 were retrospectively reviewed for data on infecting organism and success of treatment. Of 72 patients (75 knees), with a minimum of 2 years of follow-up, who completed the protocol, the infection was eradicated in 90.7% (68/75 knees). Thirty-one (91.2%) of 34 of MDR infections and 42 (91.3%) of 46 of non-MDR infections were successfully treated. These results support previous studies that demonstrated the effectiveness of a 2-stage reimplantation protocol with a standard 1:8 minimal bactericidal titer for treating infections after TKA, including MDR organisms.