Infected total knee arthroplasty. A protocol for management.

All cases of deep wound infection following total knee arthroplasty presented to the senior author between April 1977 and February 1984 were reviewed in an attempt to develop a protocol for salvaging a functional, painless knee. Two of 23 knees were eliminated because of extensive soft tissue loss. The remaining 21 infected total knee arthroplasties were analyzed. A determination of the chronicity of the infection and an evaluation of any radiolucencies were essential in determining the type of treatment used. Three distinct methods of surgical management were identified: radical debridement with retention of the initial prosthesis, one-stage reimplantation, and two-stage reimplantation. A functional uninfected total knee arthroplasty was salvaged in 18 of 21 patients, with an average follow-up period of 46 months.