From the Research
Acute knee prosthetic joint infections typically develop within the first 3 months after surgery, with most cases presenting within the first 4 weeks, as reported in a study published in 2015 1. The timeline for the development of acute prosthetic joint infections (PJIs) following knee replacement surgery is a critical factor in determining the appropriate treatment approach.
- Early postoperative infections often manifest within days to weeks of the procedure, with patients presenting with increasing pain, warmth, redness, swelling, drainage from the surgical site, and sometimes fever.
- The diagnostic timeline involves prompt evaluation with physical examination, laboratory tests (including C-reactive protein, erythrocyte sedimentation rate, and white blood cell count), joint aspiration for cell count, culture, and sensitivity testing.
- Treatment should begin immediately upon diagnosis and generally includes surgical debridement with implant retention (DAIR) if the infection is caught within 4 weeks of the index surgery and the implant is stable, as supported by a study published in 2021 2.
- This is followed by targeted antibiotic therapy, initially broad-spectrum, until culture results are available, then narrowed based on sensitivities, with the goal of minimizing morbidity, mortality, and improving quality of life.
- Antibiotic treatment typically continues for 6-12 weeks, often with 2-6 weeks of intravenous therapy followed by oral antibiotics, as discussed in a study published in 2015 1.
- Early intervention is critical as delayed treatment significantly reduces the success rate of implant retention and increases the likelihood of needing implant removal or exchange, highlighting the importance of prompt diagnosis and treatment in the management of acute knee prosthetic joint infections.