Infected Knee Replacement Revision Surgery in New York and Connecticut

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infection knee replacement

Periprosthetic joint infections (PJI) are among the most serious complications following total knee replacement surgery. These infections can compromise the success of the original procedure, cause pain and instability, and require complex surgical intervention. At Plancher Orthopaedics & Sports Medicine, we specialize in diagnosing and treating PJIs with advanced revision techniques designed to eliminate infection, restore function, and preserve mobility. Whether you’re in New York or Connecticut, our team provides the surgical expertise and personalized care needed to address these complex conditions.

Understanding Periprosthetic Joint Infection (PJI)

What Is PJI?

A periprosthetic joint infection occurs when bacteria or pathogens colonize the tissues surrounding a knee arthroplasty. This often results in the formation of biofilm, an invisible bacterial layer on the surface of the prosthesis, that is highly resistant to antibiotics. Left untreated, PJI leads to persistent pain, swelling, drainage, joint stiffness, and implant failure.

Causes and Risk Factors

Several factors contribute to the development of PJI:  

  • Surgical factors: Contamination during the initial knee replacement procedure or wound healing complications.
  • Patient-related factors: Chronic conditions such as diabetes, obesity, or a weakened immune system increase susceptibility.
  • Hematogenous spread: Infections from other areas of the body, such as dental or urinary sources, can reach the implant via the bloodstream.

The management of periprosthetic joint infections is crucial for the longevity of revision total knee replacements. Early intervention can prevent the progression of the infection and the need for more extensive surgical procedures. The healthcare team must assess each case individually, considering the patient’s overall health, the severity of the infection, and the condition of the knee joint. Strategies to prevent PJI include meticulous surgical techniques, optimizing patient health before surgery, and vigilant postoperative care. Despite these efforts, some patients may still experience infections, underscoring the importance of ongoing research and development of more effective treatment modalities.

Symptoms of an Infected Knee Implant

Early recognition of symptoms can significantly improve the outcome of revision surgery and lead to pain relief. Common signs include:  

  • Persistent or increasing knee pain, which can indicate that the infection is affecting the surrounding soft tissues and kthe nee joint.
  • Swelling or warmth around the joint, often a result of the body’s inflammatory response to the infection, which may also lead to excessive scar tissue formation.
  • Fever or systemic signs of infection, such as chills and fatigue, suggest that the infection might be spreading beyond the knee joint.
  • Drainage from the surgical site, which could be a sign of serious complications, including the presence of a biofilm on the knee replacement implant.
  • Joint stiffness or limited mobility, indicating potential damage to the knee range and function, possibly due to infection or excessive scar tissue.

Prompt evaluation and diagnosis are critical to preventing further joint damage or systemic complications, such as periprosthetic joint infections or knee replacement failure. Early intervention, including a revision procedure or targeted antibiotic therapy, can help preserve joint function and relieve pain.

Diagnostic Approach

Effective treatment begins with accurate diagnosis. At Plancher Orthopaedics, we take a multi-modal approach to ensure precise identification of the infection and its extent:

Causes and Risk Factors

A thorough clinical examination is the first step in diagnosing a knee infection. This involves a detailed evaluation of the knee, including a physical exam and review of symptoms and medical history, which helps identify the severity of infection. During the physical exam, the healthcare team assesses the knee for signs of swelling, warmth, and tenderness, which may indicate inflammation or infection. The patient’s medical history is also reviewed to identify any underlying conditions that could contribute to the infection or complicate treatment.

Laboratory Tests

Laboratory tests play a crucial role in detecting inflammatory markers that suggest an infection. Blood tests such as white blood cell count and C-reactive protein levels help detect these markers. Elevated levels of these markers can indicate an ongoing infection, prompting further investigation. In some cases, additional tests like erythrocyte sedimentation rate (ESR) may be conducted to provide more insights into the inflammatory process.

Joint Aspiration

Joint aspiration, also known as arthrocentesis, is a key diagnostic tool for identifying the infecting organism. Fluid from the joint is extracted and cultured to identify the infecting organism and guide antibiotic therapy. This procedure not only helps in confirming the presence of an infection but also aids in determining the specific bacteria or pathogens involved, allowing for targeted antibiotic treatment.

Imaging Studies

Imaging studies are essential for assessing the condition of the knee implant and surrounding bone structures. X-rays, MRIs, and CT scans assess implant positioning and bone involvement, aiding in surgical planning. These imaging modalities provide detailed visualizations of the knee joint, helping to identify any changes in the bone or implant that may be associated with infection. Advanced imaging techniques, such as nuclear medicine bone scans, may also be utilized to detect subtle changes in bone metabolism indicative of infection.

In summary, the combination of clinical examination, laboratory tests, joint aspiration, and imaging studies forms a comprehensive diagnostic approach that allows for accurate diagnosis and effective treatment planning for infected knee replacements. This multi-faceted strategy ensures that every aspect of the infection is thoroughly evaluated, enabling the healthcare team to develop a personalized treatment plan that addresses the unique needs of each patient.

Treatment Options for Infected Knee Replacements

Non-Surgical Management

For early-stage infections, targeted antibiotics and surgical debridement may be sufficient, whereas more advanced cases may require revision surgery. This approach is typically reserved for acute infections without implant loosening.

Revision Surgery

For chronic or severe infections, revision surgery is often necessary and may include:

Two-Stage Revision

  • First Stage: Removal of the infected prosthesis and placement of an antibiotic-loaded spacer.
  • Antibiotic Therapy: Intravenous antibiotics for several weeks to clear the infection.
  • Second Stage: Insertion of a new knee implant once infection is eradicated.

Single-Stage Revision

In select cases, the infected implant is removed and replaced in a single operation, followed by continued antibiotic therapy.

Alternative Procedures

If revision is not feasible due to severe bone loss or recurring infection, joint fusion or, in rare cases, amputation may be considered.

Postoperative Care and Recovery

Continued Antibiotic Therapy

Post-surgical infection control is supported by a tailored antibiotic regimen, administered orally or intravenously depending on the infection type and severity.

Physical Therapy

Customized rehabilitation programs begin shortly after surgery to restore joint strength, flexibility, and function.

Regular Monitoring

Ongoing clinical follow-up ensures successful recovery and detects any early signs of infection recurrence or complications.

Why Choose Plancher Orthopaedics & Sports Medicine?

  • Specialized Expertise: Dr. Kevin D. Plancher and our orthopedic team have deep experience with complex knee revision surgeries.
  • Advanced Techniques: We use both single- and two-stage revision methods based on infection severity, and employ robotic-assisted surgical systems for precision.
  • Personalized Care: Every treatment plan is tailored to your health status, lifestyle, and recovery goals.
  • Comprehensive Support: From consultation to recovery, we provide a coordinated care experience to optimize outcomes.
  • Faster Radiology Times: Get your MRI, CT scan, X-rays, and other important results within 24-48 hours.

Schedule a Consultation Today

If you are experiencing symptoms of infection following a knee revision or have been diagnosed with PJI, early action is critical. Plancher Orthopaedics & Sports Medicine offers comprehensive evaluation and individualized treatment plans in both our New York and Connecticut offices.  

  • New York Office:
    1160 Park Avenue, New York, NY 10128
    Phone: (646) 760-3579
  • Connecticut Office:
    31 River Road, Suite 102, Cos Cob, CT 06807
    Phone: (203) 863-2003

Take the first step toward recovery and long-term knee health with trusted expertise from Plancher Orthopaedics & Sports Medicine.

Frequently asked questions

To effectively treat a knee infection, it is crucial to act promptly by draining the infected fluid either with a needle or through surgery and administering antibiotics, either orally or intravenously. Neglecting treatment can lead to serious damage to the joint's cartilage and bone.

Symptoms of an infected knee implant include persistent pain, noticeable swelling, fever, and drainage from the surgical site. It's crucial to seek medical attention if these symptoms occur.
The main causes of periprosthetic joint infections are surgical contamination, diabetes, obesity, a history of infections, and significant bone loss. This highlights the importance of addressing these risk factors to minimize the likelihood of infection.
Diagnostic methods to identify knee implant infections encompass clinical examinations, laboratory tests, joint aspiration, and imaging studies like X-rays, MRIs, and bone scans. These approaches collectively help in accurately diagnosing the infection.
Treatment options for knee infections primarily involve non-surgical management with antibiotics, alongside surgical interventions such as single-stage and two-stage revision knee replacement surgeries. It's imperative to choose the appropriate approach based on the severity of the infection.

We are an out-of-network practice focused on delivering individualized, concierge-level orthopedic care.