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The Journal of Bone and Joint Surgery (American) 85:1952-1955 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Results of Treatment of Infection in Both Knees After Bilateral Total Knee Arthroplasty

Luther H. Wolff, III, MD, Javad Parvizi, MD, Robert T. Trousdale, MD, Mark W. Pagnano, MD, Douglas R. Osmon, MD, Arlen D. Hanssen, MD and George J. Haidukewych, MD

Investigation performed at the Mayo Clinic, Rochester, Minnesota

Luther H. Wolff III, MD
Javad Parvizi, MD
Robert T. Trousdale, MD
Mark W. Pagnano, MD
Douglas R. Osmon, MD
Arlen D. Hanssen, MD
George J. Haidukewych, MD
Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for G.J. Haidukewych: haidukewych.george{at}mayo.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to review the results and complications of treatment of simultaneous infection of both knees after bilateral total knee arthroplasty.

Methods: Between 1976 and 1999, twenty-one patients with a mean age of seventy-one years were treated for simultaneous infection of both knees after bilateral total knee arthroplasty. Two patients died within two years, and one patient was lost to follow-up after one year. The remaining eighteen patients were followed for a mean of five years. At the time of presentation, all twenty-one patients had had symptoms for less than three weeks. Eleven patients (twenty-two knees) were treated with attempts at prosthetic salvage with surgical débridement and administration of suppressive antibiotics. Resection arthroplasty was performed as the initial treatment in ten patients (twenty knees).

Results: Of the ten patients treated with initial resection, seven patients (fourteen knees) underwent subsequent reimplantation. All fourteen knees were functioning well at the time of the latest follow-up, and none had been revised at a mean of two years after reimplantation. Of the eleven patients (twenty-two knees) who had been initially treated with prosthetic salvage, nine patients (eighteen knees) had a recurrence of the infection that required a reoperation (bilateral resection arthroplasty in seven patients, bilateral above-the-knee amputation in one patient, and repeat débridement of both knees in one patient). Two of the seven patients who had resection underwent reimplantation six weeks postoperatively, and the other five patients (ten knees) did not have reimplantation because of low functional demands and prohibitive medical comorbidity.

Conclusion: We believe that treatment of simultaneous infection of both knees after bilateral total knee arthroplasty should consist of bilateral resection arthroplasty and delayed reimplantation after a period of intravenous administration of organism-specific antibiotics.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


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J. M. Leone and A. D. Hanssen
Management of Infection at the Site of a Total Knee Arthroplasty
J. Bone Joint Surg. Am., October 1, 2005; 87(10): 2335 - 2348.
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