From the Guidelines
Surgical site infection (SSI) after total knee arthroplasty (TKA) is primarily treated with surgical intervention, including debridement and implant retention (DAIR) or prosthesis exchange, along with antimicrobial therapy.
Treatment Approaches
- Debridement and implant retention (DAIR): This involves arthrotomy and debridement of the affected joint, usually in conjunction with exchange of removable components such as the polyethylene insert of a TKA 1.
- Prosthesis exchange: This involves the removal of the infected prosthesis with implantation of a new prosthesis either during the same operation or as a separate operation after an interval of antimicrobial treatment 1.
Antimicrobial Therapy
- Empiric antibiotic treatment: Should be initiated in patients with incisional SSIs and signs of systemic inflammatory response or organ failure 1.
- Antibiotic choice: Should be guided by the suspected or confirmed causative microorganism, as well as the site of surgery 1.
Wound Management
- Incision and drainage: The primary and most important therapy for SSI is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention 1.
- Dressing changes: Should be continued until the wound heals by secondary intention 1.
Patient Factors
- Host defenses: The integrity of host defenses is an important determinant of SSI, with factors such as age, malnutrition, diabetes, and smoking playing a role 1.
- Patient comorbidities: Should be taken into account when deciding on treatment approaches, with consideration given to the patient's overall health and ability to undergo surgical intervention 1.
From the Research
Treatment for Surgical Site Infection (SSI) after Total Knee Arthroplasty (TKA)
- The treatment for SSI after TKA depends on the severity and type of infection, with options including oral antibiotics for superficial infections 2 and repeated procedures such as debridement, implant removal, and/or revision arthroplasty for prosthetic joint infections (PJI) 2, 3.
- For early cases of PJI, treatment may involve early revision with debridement and implant retention (DAIR), while late infections may require staged revision with the use of a fixed or mobile antibiotic spacer 3.
- In some cases, a single-stage operation with the use of local and systemic antibiotic treatment may be performed 3.
- The management of PJI after TKA requires a standardized procedure for diagnostic workup and surgical management, including a distinct workup of diagnostic steps and evaluation of results in a multidisciplinary setup 3.
Risk Factors for SSI after TKA
- Longer operative duration has been associated with an increased risk of SSI after TKA 2.
- Other potential risk factors for SSI after TKA include the type of prosthesis used, with some studies suggesting that certain types of prostheses may be associated with a higher risk of infection 4.
- Traffic through the operating room door, non-standard air conditioning, and the presence of a tool-washing sink have also been identified as potential risk factors for SSI after TKA 4.
Prevention of SSI after TKA
- Closed incision negative pressure wound therapy (ciNPWT) has been shown to decrease the risk of SSI after revision TJA, but its use after primary TJA is still being studied 5.
- ciNPWT may increase the risk of non-infectious wound complications, such as wound blistering, after primary TKA 5.
- Proper infection control measures, including post-discharge surveillance, are essential for preventing and managing SSI after TKA 6.