Maximizing patient care and outcomes in knee arthroplasty prosthetic joint infection

Arthroscopy (with its role limited to the temporizing and/or stabilization of an acutely septic patient, with a possible role in diagnosis for organism identification through tissue specimen acquisition) DAIR, single stage revision, two stage revision, conservative management with long-term infection suppression (non-curative), and salvage procedures (including knee fusion and above knee amputation.) Early diagnosis and patient direction to the care of a MDT, also potentially allows for more diverse surgical intervention options, including DAIR, and single stage revision surgery. [5], in “Debridement, antibiotics and implant retention (DAIR) for the management of knee prosthetic joint infection,” notes that, “Although no strict time limits should be placed upon the decision to undertake DAIR in appropriate cases, infection that has been present for at least four to six weeks is more likely to have a mature biofilm that would be more difficult to eradicate without removal of all foreign material.” (Porteous [6]) Finally, in some instances, cure, “defined as freedom from clinical signs and symptoms of infection, normalised biochemical parameters (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and no further requirement for surgical intervention or antibiotic therapy at two years post-treatment,” (Kalson [1]) may not be possible.