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Mayo Clinic Review of Knee Infection after Bilateral Joint Replacement

Many people in rural areas depend on the Mayo Clinic in Rochester, Minnesota, for information on how and when to treat unusual health problems. Joint infection in both knees after a total joint replacement is one of those conditions.

There are no studies so far on how to treat this problem. What works best? Doctors at the Mayo Clinic reviewed the charts of 21 patients treated between 1976 and 1999 to find out. Two-thirds of the patients had an increased risk for infection because of other health problems such as diabetes, kidney disease, and cancer.

Many infections occur within the first three weeks after a joint replacement. In fact, half of all infections occur in the first week after the implant operation. There are different ways to treat this problem. Sometimes the doctor tries to save the new joint. They do this by cleaning out the infection and replacing part of the implant.

In some cases the infected implant is removed, and a temporary spacer is put in its place. A new implant is inserted when the infection is under control. Other patients need a new joint replacement right away. In all patients an antibiotic is used to kill the bacteria. The medication is given intravenously, by mouth, or painted on the parts put in the knee. To be on the safe side, most patients are also put on long-term oral antibiotics.

The authors found that keeping the infected implant always had a poor result. Waiting too long to replace an infected implant was equally bad. Removing the implant and clearing up the infection before putting in a new implant seems to work the best.

However, not all patients can be treated this way. Some patients have other health concerns that get in the way. The best treatment takes place during two separate operations. The patient may not be able to handle that much time in surgery. Options are fairly limited in these cases.

Since this study included patients from 1976 on, the researchers think results today may be better. They recommend removing all hardware and cement. The joint should be cleaned carefully. Treatment with intravenous antibiotics is advised next. Any spacer or implant reinserted should be painted with antibiotics or held in place with antibiotic-treated glue.

References: Luther H. Wolff III, MD, et al. Results of Treatment of Infection in Both Knees after Bilateral Total Knee Arthroplasty. In Journal of Bone and Joint Surgery. October 2003. Vol. 85-A. No. 10. Pp. 1952-1955.

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