Background: The ultimate goal of the treatment of infectious knee arthritis is to protect the articular cartilage from
adverse effects of infection. Treatment, however, is not always hundred percent successful and has a 12% failure
rate. Persistent infection is more likely to happen in elderly patients and those with underlying joint diseases,
particularly osteoarthritis. Eradication of infection and restoration of function in the involved joint usually are
not possible by conventional treatment strategies. There are few case series reporting two-stage primary knee
arthroplasty as the salvage treatment of the septic degenerative knee joint; however, the treatment protocol remains
to be elucidated.
Methods: Based on a proposed approach, patients with failure of common interventions for treatment of septic knee
arthritis and underlying joint degeneration were treated by two-stage TKA and intervening antibiotic loaded static
cement spacer. Suppressive antibiotic therapy was not prescribed after the second stage.
Results: Complete infection eradication was achieved with mean follow up of 26 months. All cases were balanced with
primary total knee prosthesis. The knee scores and final range of motions were comparable to other studies.
Conclusion: The two-stage total knee replacement technique is a good option for management of failure of previous
surgical treatment in patients with septic arthritis and concomitant joint degeneration. Our proposed approach enabled
us to use primary prosthesis in all of our patients with no need for suppressive antibiotic therapy.
Level of evidence: IV