CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2022; 63(02): e87-e92
DOI: 10.1055/s-0042-1750697
Artículo Original | Original Article

Periprosthetic Infections in Total Knee Arthroplasty: What Is Our Reality?

Article in several languages: español | English
Alex Vaisman
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
Juan Pablo Casas-Cordero
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
Sebastián Bianchi
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
Diego Edwards
1   Departamento de Ortopedia y Traumatología, Hospital Padre Hurtado y Clínica Alemana, Santiago, Chile
› Author Affiliations


Introduction Periprosthetic infection (PPI) is one of the most serious complications in total knee arthroplasty (TKA). Despite this, there is little Chilean literature regarding this pathology.

Objectives To determine the incidence, comorbidities, isolated microorganisms and their antibiotic susceptibility, morbidity, and mortality in patients with PPI.

Materials and Methods A descriptive and retrospective study in patients operated between 2001 and 2020 for gonarthrosis, with a primary TKA, in the same health center, with at least 1 year of follow-up. Patients operated on in other centers or with incomplete clinical records were excluded. Comorbidities, isolated microorganisms, antibiotic susceptibility, and survival were recorded through a systematic search of the clinical records of patients with PPI. Descriptive statistics were used to present the data.

Results We included 544 TKAs, 8 (1.47%) of which presented PPI, and the patients had an average age at presentation of 66 years (±5.7 years) and an average body mass index (BMI) of 30.3 (±4, 5) kg/m2. The median time of presentation of the PPI was of 411 (±1,034) days. The main comorbidities recorded were arterial hypertension in 5 (62.5%), smoking in 4 (50%) cases, and dyslipidemia in 4 (50%) cases. In total, 5 (62.5%) patients presented polymicrobial etiology, and in 3 (37.5%), a single microorganism was isolated. The main isolated agents were Staphylococcus aureus and coagulase-negative Staphylococcus, both multidrug-resistant, in 6 (75%) and 3 (37.5%) patients respectively. All patients received three doses of cefazolin as surgical prophylaxis. A sensitivity of 100% to vancomycin and rifampicin (12/12 cultures), and a resistance of 83.4% to ciprofloxacin (4/9 cultures) were described. Overall, 2 (25%) patients died 3 years after the TKA, due to causes unrelated to PPI. There were no cases of infectious relapse after the review.

Conclusion An incidence of 1.47% (8 cases) of PPI was found. All patients with PPI presented some presurgical comorbidity. The main microbiological agents identified were multidrug-resistant and susceptible to vancomycin and rifampicin.

Publication History

Received: 01 December 2021

Accepted: 17 May 2022

Article published online:
03 October 2022

© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

  • Referencias

  • 1 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
  • 2 Blanco JF, Díaz A, Melchor FR, da Casa C, Pescador D. Risk factors for periprosthetic joint infection after total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140 (02) 239-245 DOI: 10.1007/s00402-019-03304-6.
  • 3 Lenz R, Paredes D, Edwards D, Galvez P. 2020 Evaluación económica en salud: costo-utilidad de la incorporación del reemplazo total de rodilla en la cobertura del régimen de Garantías Explícitas en Salud en Chile. [online] [Accessed 5 May 2021]. at:
  • 4 Ricciardi BF, Muthukrishnan G, Masters EA, Kaplan N, Daiss JL, Schwarz EM. New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection. J Orthop Res 2020; 38 (07) 1423-1435 DOI: 10.1002/jor.24595.
  • 5 Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. INFORM Team. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One 2016; 11 (03) e0150866 DOI: 10.1371/journal.pone.0150866.
  • 6 Premkumar A, Morse K, Levack AE, Bostrom MP, Carli AV. Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: Prevention and Diagnosis. Curr Rheumatol Rep 2018; 20 (11) 68
  • 7 Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: new guidelines. Bone Joint Lett J, 99-b (2017), pp. 3-10
  • 8 Henk E, Brian D, Ian S. et al. Can short term (two weeks or less) antibiotic treatment be considered following resection arthroplasty for chronic periprosthetic joint infections (PJIs)? Proceedings of the International Consensus Meeting on Prosthetic Joint Infection. Philadelphia: 2018 . Part II-Hip and Knee: 500–501. Available at:
  • 9 Parvizi J, Tan TL, Goswami K. et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 2018; 33 (05) 1309-1314.e2 DOI: 10.1016/j.arth.2018.02.078.
  • 10 Huerfano E, Bautista M, Huerfano M, Bonilla G, Llinas A. Screening for infection before revision hip arthroplasty: a meta‐analysis of likelihood ratios of erythrocyte sedimentation rate and serum C‐reactive protein Levels. J Am Acad Orthop Surg 2017; 25 (12) 809-817
  • 11 Lee YS, Koo KH, Kim HJ. et al. Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta‐analysis. J Bone Joint Surg Am 2017; 99 (24) 2077-2084
  • 12 Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996; 78 (04) 512-523
  • 13 Workgroup Convened by the Musculoskeletal Infection Society. New definition for periprosthetic joint infection. J Arthroplasty 2011; 26 (08) 1136-1138
  • 14 Porrino J, Wang A, Moats A, Mulcahy H, Kani K. Prosthetic joint infections: diagnosis, management, and complications of the two-stage replacement arthroplasty. Skeletal Radiol 2020; 49 (06) 847-859 DOI: 10.1007/s00256-020-03389-w.
  • 15 Coventry MB. Treatment of infections occurring in total hip surgery. Orthop Clin North Am 1975; 6 (04) 991-1003
  • 16 Fitzgerald Jr RH, Nolan DR, Ilstrup DM, Van Scoy RE, Washington II JA, Coventry MB. Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 1977; 59 (07) 847-855
  • 17 Lima AL, Oliveira PR, Carvalho VC, Saconi ES, Cabrita HB, Rodrigues MB. Periprosthetic joint infections. Interdiscip Perspect Infect Dis 2013; 2013: 542796 DOI: 10.1155/2013/542796.
  • 18 Carvalho VC. Osteomielite por bacilos Gram-negativos: estudo comparativo das características clínico-microbiológicas e fatores de risco com as infecções por Staphylococcus aureus[tese]. São Paulo: : Faculdade de Medicina da Universidade de São Paulo; 2013
  • 19 Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2016; 387 (10016): 386-394 DOI: 10.1016/s0140-6736(14)61798-0.
  • 20 Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468 (01) 52-56 DOI: 10.1007/s11999-009-1013-5.
  • 21 Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 2017; 14 (03) 529-536 DOI: 10.1111/iwj.12640.
  • 22 Broughton N, Collopy D, Solomon M. Arthroplasty Society of Australia. Arthroplasty Society of Australia position statement on follow-up of joint replacement patients. 2016 = 2 (date last accessed 01 September 2017).
  • 23 Meding JB, Ritter MA, Davis KE, Farris A. Meeting increased demand for total knee replacement and follow-up: determining optimal follow-up. Bone Joint J 2013; 95-B (11) 1484-1489
  • 24 Jaén F, Sanz-Gallardo MI, Arrazola MP, García de Codes A, de Juanes A, Resines C. Grupo de Trabajo INCLIMECC de la Comunidad de Madrid. Estudio multicéntrico sobre la incidencia de infección en prótesis de rodilla. Rev Esp Cir Ortop Traumatol 2012; 56 (01) 38-45
  • 25 Girón-Cornelio MF. Infecciones de prótesis de rodilla. Rev Méd Panacea 2019; ;8(1): 46-54
  • 26 Leijtens B, Elbers JBW, Sturm PD, Kullberg BJ, Schreurs BW. Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study. BMC Infect Dis 2017; 17 (01) 321 DOI: 10.1186/s12879-017-2429-2.
  • 27 Gellert M, Hardt S, Köder K, Renz N, Perka C, Trampuz A. Biofilm-active antibiotic treatment improves the outcome of knee periprosthetic joint infection: Results from a 6-year prospective cohort study. Int J Antimicrob Agents 2020; 55 (04) 105904 DOI: 10.1016/j.ijantimicag.2020.105904.