Surgical and Therapeutic Approaches in Total Knee Arthroplasty for Patients with Osteomyelitis: A Systematic Review
Abstract
Total knee arthroplasty (TKA) in patients with osteomyelitis poses significant challenges related to infection eradication and joint functional restoration. This study aimed to systematically review the best available evidence on surgical techniques, prosthesis types, cement options, and antibiotic protocols employed in this context. The methodology adhered to the PRISMA framework, analyzing clinical and experimental studies published between 2014 and 2024 across PubMed, ScienceDirect, Scopus, and Medline databases. Forty studies were included, evaluating approaches such as two-stage revisions, antibiotic-impregnated spacers, and specific prosthesis designs. The results demonstrated high infection eradication rates (above 90%) with two-stage techniques, particularly when using articulating spacers, which provided superior functional outcomes. Antibiotic-impregnated cements, such as those containing vancomycin and gentamicin, proved effective in controlling local infections. We conclude that multidisciplinary approaches, combining advanced surgical techniques and personalized antibiotic management, are essential for achieving clinical and functional success in these patients. Future research should explore innovative materials and protocols to further enhance outcomes.
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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