Two Stage Exchange for Infected TKA


This is a 72 year old female with a history of diabetes and peripheral vascular disease who underwent total knee replacement 8 years ago. She did well with no issues. Unfortunately she developed systemic sepsis with Group B Streptococcus and presented with a month of knee pain. Her lab work, ESR and CRP, were elevated. Synovial fluid aspiration revealed WBC 7200, PMN 91%, and cultures positive for Strep agalactiae.

She underwent two stage exchange for infected TKA. During stage one, the prior knee implants were meticulously removed, and an articulated antibiotic spacer was placed using knee replacement implants, high dose antibiotic cement, and absorbable antibiotic beads. She was treated with IV antibiotics for 6 weeks. She underwent stage two reimplantation approximately three months later. The knee was reconstructed using a constrained condylar revision implant, hybrid/diaphyseal engaging stems, and a trabecular metal tibial cone.

The patient did well after surgery. She has had no recurrence of infection and is back to full function.