Windsor et al. report outcomes of 38 infected total knee arthroplasties (35 patients) treated with a three-phase two-stage reimplantation protocol at HSS: explantation with debridement, six weeks of IV antibiotics targeting a serum bactericidal titer ≥1:8, then reimplantation. The study extends follow-up of a previously reported cohort and adds 29 new knees to refine indications and identify patient subgroups at risk for failure.
When managing an infected TKA in an immunocompromised patient or one with polyarticular rheumatoid arthritis, counsel them that the two-stage protocol controls the index infection reliably but carries meaningful risk of subsequent hematogenous reinfection with a new organism.
Always aspirate the joint directly — sinus tract cultures miss the causative organism in over 70% of cases and will underestimate polymicrobial infection.
Windsor et al. report outcomes of 38 infected total knee arthroplasties (35 patients) treated with a three-phase two-stage reimplantation protocol at HSS: explantation with debridement, six weeks of IV antibiotics targeting a serum bactericidal titer ≥1:8, then reimplantation. The study extends follow-up of a previously reported cohort and adds 29 new knees to refine indications and identify patient subgroups at risk for failure.
When managing an infected TKA in an immunocompromised patient or one with polyarticular rheumatoid arthritis, counsel them that the two-stage protocol controls the index infection reliably but carries meaningful risk of subsequent hematogenous reinfection with a new organism.
Always aspirate the joint directly — sinus tract cultures miss the causative organism in over 70% of cases and will underestimate polymicrobial infection.