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Team Approach: The Management of Infection After Total Knee Replacement

Yan, Chun Hoi MBBS, FRCS1; Arciola, Carla Renata MD, PhD2,3; Soriano, Alex MD, PhD4; Levin, L. Scott MD5; Bauer, Thomas W. MD, PhD6; Parvizi, Javad MD, MS, FRCS7,a

doi: 10.2106/JBJS.RVW.17.00058
Review Article-Team Approach
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Disclosures

  • * Diagnosis and management of infection after total knee arthroplasty are challenging. They require a multidisciplinary team approach, much like the management of musculoskeletal tumors.
  • * Patients presenting with suspected infection after total knee arthroplasty require diagnostic confirmation, medical optimization, comprehensive surgical care that may include measures to cover the soft tissues, administration of long-term antibiotics, and extended rehabilitation to improve outcome.
  • * Surgeons should work closely with infectious disease specialists or microbiologists at every step to minimize the perioperative risks of reinfection, should decide on the most appropriate surgical modality and antibiotic regime, and should monitor the response to therapy.
  • * The current evidence on the best surgical management of infection after total knee arthroplasty (debridement and retention of prostheses compared with 1-stage exchange or 2-stage exchange arthroplasty) is lacking. Randomized, prospective studies that are under way may provide this much-needed information.

1Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People’s Republic of China

2Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy

3Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

4Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Spain

5Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

6Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY

7Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania

aE-mail address for J. Parvizi: parvj@aol.com

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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