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I was told that there could be problems after my surgery to replace my knee...you know, the usual warnings everyone gets about infection, failure to heal, blood clots, heart attacks and what have you. I never imagined myself actually having any problems. But here I am two weeks later with a raging infection. I'm seeing the doctor tomorrow. What can I expect to happen next?

All indications are from studies reported that infection after total knee replacement is a problem that is on the rise. With "bugs" (bacteria) more resistant than ever to antibiotics, it can be a challenging problem to treat. It may require removal of the implant and revision surgery to put in a second implant. Treatment depends somewhat on the type of knee infection present. These are classified as one of four types: 1) infection present at the time of the primary total knee arthroplasty, 2) infection develops within the first 30-days after surgery, 3) infection goes into the blood but symptoms only last four-weeks, and 4) a chronic infection lasting more than 30-days. Treatment is based on the infection type and condition of the patient. Treatment choices include: antibiotics, irrigation and debridement, removal and replacement of the implant, arthrodesis (fusion), and (worse case scenario): amputation. Who gets what treatment? Antibiotics alone (called antibiotic suppression) is very ineffective (20 per cent success rate) and only used for a small number of patients. These are folks who are too sick for surgery, who have a stable implant (not loose), and a bacteria that is considered "low virulence" (in other words, not terribly strong or destructive). The preferred treatment is actually more of a combined management approach. Open incision with irrigation and debridement works best for acute infections. But the surgeon must take into consideration several factors when using just this approach. For example, your health, the type of bacteria present, the length of time since the primary surgery, and other patient risk factors must be reviewed and assessed before choosing the best treatment option for each patient. More often, it is necessary to remove the infected implant, clean out the joint, and replace some of the component parts of the implant. The replacement procedure is referred to as an exchange arthroplasty. The exchange arthroplasty can be a one-step or two-step process (also known as one-stage or two-stage exchange arthroplasty). As the names suggest, in a one-stage procedure, everything is done in one surgery. In a two-stage exchange, the implant is removed but not replaced just yet. Instead a spacer that contains high-dose antibiotics is put in place instead. Once the infection is under control, then the spacer is removed and the replacement implant installed. Usually the antibiotics are used for at least six weeks with another four to six weeks time period off antibiotics before reimplantation can take place. Once the lab tests show the infection is cleared up, then the exchange can take place. The more extreme options of joint fusion or even amputation are only considered when all other treatment methods have failed. Amputation may be necessary when the infection cannot be stopped and the patient is either in terrible pain or their life is threatened by the infection spreading throughout the body. In all cases, every effort is made to save the leg, save the joint, save the implant. Fusion and/or amputation are only considered when all else has failed. Since your infection has been identified early, you are in a good position to receive the medical care necessary to prevent any of these more extreme measures. Once the surgeon assesses your situation, he or she can give you a better idea of your choices. What we presented here is a range of possibilities.

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