Are Patients With a History of Septic Arthritis Undergoing Total Knee Arthroplasty at Higher Risk for Revision Surgery? A Single-Center Study

Background: The decision to perform a total knee arthroplasty (TKA) on a previously infected knee is made complicated by the higher risk for both a periprosthetic joint infection (PJI) and early failure. There is currently no standard in the treatment strategy for this group of patients. We here report the outcomes of performing a primary TKA on patients with a prior septic knee arthritis. The aim of our study is to analyze the survival rates of patients with a history of septic arthritis undergoing TKA.

Methods: From 2010 to 2018, all patients treated in our institution with a minimum follow-up of 1 year, who have previous histories of knee joint infections and underwent a primary TKA were included in the study. All patients underwent the same surgical protocol and were given systemic and local antibiotic treatment.

Results: Of the 68 knees, there were 4 surgical revisions (5.9%). These included 2 septic revisions due to PJI (2.9%), 1 open arthrolysis for arthrofibrosis (1.5%), and 1 aseptic revision for implant loosening (1.5%). Sixty-four (64) knees (94%) had survived without any surgical interventions and the Kaplan-Meier analysis demonstrated an overall survivorship free from PJI of 97.1% at a mean of 5 years (range 1-9, standard deviation ±2.5 years).

Conclusion: TKA is a suitable option for patients with a prior septic arthritis of the knee, provided that proper surgical technique and the utilization of systemic and local antibiotics are employed.

Level of evidence: Level III, therapeutic study.