Treatment options for infected knee arthroplasties.

Twenty-four total knee arthroplasty infections in 23 patients treated over a 9-year period at the University of Texas Medical Branch at Galveston were retrospectively reviewed. Staphylococcus epidermidis was isolated from 11 of 24 and Staphylococcus aureus from eight of 24 knees, respectively. Eleven infections were polymicrobic. Control of infection was obtained in 13 of 13 patients treated initially with resection arthroplasty, and 11 of these were ambulatory at follow-up. Infection was controlled in three of 10 knees treated initially with debridement, and six of these nine patients were ambulatory at follow-up. One patient was initially treated with amputation. Four of four patients treated by resection arthroplasty and then by reimplantation were ambulatory without signs of infection at follow-up. Resection arthroplasty reliably controls infection but produces a painful unstable joint that requires brace support or subsequent surgery for pain-free ambulation. Reimplantation in selected patients offers the best chance for pain-free ambulation.