Surgical and Therapeutic Approaches in Total Knee Arthroplasty for Patients with Osteomyelitis: A Systematic Review

Abstract

Mario Soares Ferreira Junior, Cristiano Ricardo Martins Teixeira, Pedro Carvalho Brandao, Isaias Chaves dos Santos, Fernando Ono, Gilberto dos Santos Nogueira and Erika Freire Cavalcante Fernandes

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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