Prosthetic joint infections following a total knee arthroplasty: A retrospective analysis

Abstract

Background: Total knee arthroplasty, especially, has been a resort for many individuals plagued with deforming joint pathologies, alleviating pain, and improving joint mobility, but is not without complications. Prosthetic joint infection (PJI) is the most commonly occurring early and late complication of total knee arthroplasty. In one study, they observed that even though the rate of PJI after TKA is 0.6-0.9%, the financial burden is enormous. Therefore, it is imperative for surgeons to find the ideal management strategies, both non-surgical and surgical, to tackle PJI. Here, we conducted this study to demonstrate the occurrence of PJI following an uneventful arthroplasty, and the management strategies in a tertiary care hospital. Methods and materials: This was a retrospective study performed in the Department of Orthopaedics, Kanachur Institute of Medical sciences, between January 2021 to January 2023. The case records of all patients with culture proven prosthetic joint infection was identified. Demographic details, surgery performed, type of implant, duration of surgery, ICU stay, intra-operative and post-operative complications were recorded in a semi-structured pro forma. The data was analysed using SPSS v20. A p value < 0.05 was considered statistically significant. Results: The most common presenting complaint in the patients was pain and fever > 38 degrees C (67.5%), followed by discharge from wound site (34.23%). Four patients required ICU admission due to features of sepsis, and 2 patients died following the revision surgery. Most common organism isolated was Staphylococcus aureus in the synovial fluid cultures. We found that there was a statistically significant difference in the operative time between single staged and two staged procedure, but there was no correlation between that and the re-infection rates. Conclusion: PJI following TKA is a dreadful complication, which requires swift diagnosis and prompt management. Most patients present with pain initially, which should alert the treating physician towards an ongoing inflammatory process in the joint. Appropriate antibiotics, single stage/two-staged surgical correction and adequate limb movement restriction can aid in reducing risk of morbidity while maintaining functionality in the operated joint.