Journal of Clinical & Experimental Orthopaedics

INADEQUATE EVALUATION AND MANAGEMENT OF SUSPECTED INFECTIONS AFTER TKA SURGERY- A REPORT FROM THE LITHUANIAN ARTHROPLASTY REGISTER ON 2,769 PATIENTS WITH TWO YEAR FOLLOW-UP

Backgrounds & Purpose: The evidence-based algorithms for the treatment of periprosthetic joint infection (PJI) recommend surgical intervention in combination with use of systemic antibiotics. However, still it is not unusual to treat Total Knee Arthroplasty (TKA) patients with suspected infection only using antibiotics (AB). The aim of our study was to investigate treatment pathways for patients after TKA with suspected infection in Lithuania. Patients & Methods: Of the 4,069 TKA patients (4,269 knees) registered in the Lithuanian Arthroplasty Register 2,769 patients (2 825 knees), were interviewed two years after the surgery. The patients were inquired if they had been subject to AB treatment after the TKA surgery and/or if any additional surgical interventions on the operated knee had been performed. The number of patients treated with antibiotics due to problems in the operated knee was identified and Cumulative Revision Rates (CRR) were calculated. Results: 188 (6 %) patients out of the 2,769 reported that they had been prescribed AB after the primary TKA, 132 patients (70%) said they had received AB due to problems with the operated knee. Out of the 132 patients, 68 (51.5%) reported that the reason for the AB treatment had been infection prophylaxis, while the remaining 64 patients (48.5%) reported that the reason for the treatment had been that the physician had suspected a prosthetic joint infection (redness, pain, swelling on operated knee, wound leakage). The two- year CRR after TKA in patients not treated with AB was 0.7% (CI 0.4; 1), as compared to 23.6% (CI 17.3; 31.7) in those who had used antibiotics due to the problems in operated knee for more than one week. Interpretation: In Lithuania there seems to be a lack of adherence to evidence based treatment guidelines when infection is suspected after primary TKA.

Egle Terteliene