Periprosthetic joint infection after total knee arthroplasty. Lessons learned: a case report and literature review

Abstract

Introduction. The increasing proportion of the aging population and overweight people with various joint problems leads to an increased demand for joint replacements. As the number of joint arthroplasty surgeries continues to rise, the persistent incidence of periprosthetic joint infections highlights the need for a comprehensive and evolving approach. In addition to the preoperative period, it is also necessary to consider the course of the intraoperative, and to a greater extent the postoperative period, when the development of periprosthetic infection occurs. This case is indicative of the fact that underestimation of the importance of the postoperative period and control of risk factors can lead to the recurrence of infection. This negatively affects the economy due to an increase in the number of disabilities.Case presentation. A 60-year-old female patient was diagnosed with a periprosthetic joint infection following total knee arthroplasty. The patient's premorbid background was aggravated by the presence of type 2 diabetes mellitus, arterial hypertension, secondary cardiomyopathy, and chronic iron-deficiency anemia. Single stage revision of knee arthroplasty, removal of prosthetic components, excision of degenerative tissue, prolonged antibiotic therapy as well as rehabilitation were ineffective, and the pain increased. Therefore, the patient is admitted for the two-stage revision surgery, removal of the endoprosthesis, and installation of a nonarticulating cement spacer of the left knee joint.Conclusion. Through a relevant literature search, we believe that uncorrected chronic iron-deficiency anemia in combination with uncontrolled diabetes mellitus, both in the preoperative and postoperative period for joint replacement, may increase the risk of the development of periprosthetic infection. Moreover, focusing patients' attention on the importance of the postoperative period and strict monitoring of health indicators will help reduce the likelihood of re-prosthetics.