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The Journal of Bone and Joint Surgery, Vol 68, Issue 2 226-234, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Deep sepsis following total knee arthroplasty. Ten-year experience at the University of California at Los Angeles Medical Center
TJ Grogan, F Dorey, J Rollins and HC Amstutz
Between September 1971 and May 1982, at the University of California at Los
Angeles Medical Center, 821 total knee arthroplasties were performed in 604
patients, all of whom received perioperative antibiotics. Deep sepsis,
proved by a positive culture of a specimen obtained by postoperative
arthrocentesis, developed fourteen times in thirteen knees of twelve
patients, an incidence of 1.71 per cent. In one of these patients, who had
systemic lupus erythematosus and bilateral knee replacement, the right knee
became infected with two distinct organisms on two different occasions
(separated by ten months). The first infection was probably hematogenous
while the second, developing after a dental procedure, definitely was.
Over-all, five infections were hematogenous with an identified source and
one other was suspected of having a hematogenous origin. The time from
operation to the diagnosis of sepsis averaged 8.3 months over-all, but five
of the fourteen infections were recognized less than two months after
arthroplasty. For the six infections that were assumed to be hematogenous,
the time from operation to the diagnosis of sepsis averaged 16.4 months.
The major presenting symptom was pain in thirteen of the fourteen
infections. The initial treatments of the fourteen infections consisted of
intravenous antibiotics in all of them, primary removal of the prosthesis
and so-called exchange arthroplasty after five days in one, removal of the
prosthesis and fusion in one, arthrotomy and debridement in six,
arthroscopic irrigation in three, and antibiotics alone in three (of which
one was treated with an exchange arthroplasty after three weeks). At last
follow-up, only four of the thirteen prostheses had been salvaged.(ABSTRACT
TRUNCATED AT 250 WORDS)
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