Intro -- Foreword -- References -- Foreword -- Preface -- Contents -- Part I: Introduction -- 1: Epidemiology andSocioeconomic Impact ofInfections inKnee Replacement -- 1.1 Introduction -- 1.2 Epidemiology andSocioeconomic Burden ofPJIs inTKA -- 1.3 The Psychological Impact ofPJIs -- 1.4 Conclusion -- References -- 2: Etiology andPathogenesis ofKnee Replacement Infections -- 2.1 Introduction -- 2.2 The Different Ways toInfect aProsthetic Joint -- 2.2.1 Direct Inoculation During Invasive Procedures -- 2.2.2 Inoculation by Contiguous Spread -- 2.2.3 Inoculation by Hematogenous Spread -- 2.3 Epidemiology -- 2.3.1 Knee vs. Hip Location -- 2.3.2 Antimicrobial Resistance -- 2.3.3 Time toPJI-Onset -- 2.3.4 Main Pathogens Involved -- 2.4 The Pathophysiology ofChronic PJI -- 2.4.1 Biofilm inTKA Infection -- 2.4.2 Attachment -- 2.4.3 Accumulation/Maturation -- 2.4.4 Detachment/Dispersal -- 2.4.5 Bacterial Interactions withBone Cells -- 2.5 Conclusion -- References -- Part II: Biomaterials in Artificial Joint Replacements -- 3: The Role oftheSurface onBacteria-Implant Interactions -- 3.1 Introduction -- 3.2 Mechanism ofImplant Biofilm Formation -- 3.3 Mechanisms ofAntibiotic Resistance inBiofilms -- 3.4 Microbiology of Periprosthetic Infection (PJI) -- 3.5 Methods fortheDetection ofBiofilms -- 3.6 The Treatment ofPJI Biofilm After TKA -- 3.7 Conclusions -- References -- 4: In-Vitro andIn-Vivo Models fortheStudy ofProsthetic Joint Infections -- 4.1 In-Vitro Models ofPJI -- 4.1.1 Bacterial Adherence -- 4.1.2 Biofilm -- 4.1.3 Antimicrobial Efficacy -- 4.1.4 Modelling forRisk Factors -- 4.1.5 Limitations -- 4.2 In-Vivo Models ofPJI -- 4.2.1 Animal Characteristics -- 4.2.2 Prosthetic Designs -- 4.2.3 Gram-Positive Models -- 4.2.4 Gram-Negative Models -- 4.2.5 Biofilm Formation

4.2.6 Immune Reactions -- 4.2.7 Limitations -- 4.3 Conclusion -- References -- Part III: Clinical Manifestation -- 5: General andLocal Symptoms ofInfection inKnee Replacement -- 5.1 Introduction -- 5.2 General Consideration -- 5.3 Clinical Examination -- 5.4 Presenting Symptoms andClinical Assessment -- 5.5 Wound Complications -- 5.6 Conclusions -- References -- Part IV: Diagnosis -- 6: Laboratory Diagnosis ofPeriprosthetic Joint Infections -- 6.1 Introduction -- 6.2 Peripheral Blood Tests -- 6.2.1 Erythrocyte Sedimentation Rate andC-Reactive Protein -- 6.2.2 d-Dimer -- 6.2.3 Fibrinogen -- 6.2.4 Interleukin-6 -- 6.2.5 Procalcitonin -- 6.2.6 Novel Serological Markers -- 6.3 Synovial Fluid Analysis -- 6.3.1 White Blood Cell Count andPolymorphonuclear Neutrophil Percentage -- 6.3.2 Leukocyte Esterase -- 6.3.3 Alpha-Defensin -- 6.3.4 Synovial CRP -- 6.3.5 Novel Synovial Fluid Markers -- 6.4 Frozen Section Histopathology -- 6.5 Microorganism Identification -- 6.5.1 Synovial Fluid Cultures -- 6.5.2 Intraoperative Tissue Cultures -- 6.5.3 Sonication Fluid Cultures -- 6.5.4 Culture-Negative Infections -- 6.5.5 Antibiotics andCulture Yield -- 6.5.6 Molecular Tests -- 6.6 Conclusion -- References -- 7: Microbiological Diagnosis ofKnee Prosthesis Infections -- 7.1 Introduction -- 7.2 Types ofSamples -- 7.2.1 Preoperative Samples -- 7.2.2 Peri-operative Samples -- 7.3 Bacteriological Analysis -- 7.3.1 Microscopic Examination -- 7.3.2 Culture -- 7.4 Molecular Biology -- 7.5 Interpretation -- References -- 8: Molecular Analysis andHistological Evaluation -- 8.1 Introduction -- 8.2 Molecular Analysis -- 8.2.1 PCR -- 8.2.2 NGS -- 8.2.3 Histological Evaluation -- 8.3 Conclusions -- References -- 9: Imaging -- 9.1 Introduction -- 9.2 Ultrasound (US) -- 9.3 Radiography -- 9.4 Resonance Imaging

9.5 Computerized Tomography Imaging -- 9.6 Single-Photon Emission Computed Tomography withComputerized Tomography (SPECT/CT) -- 9.7 Bone Scintigraphy/Three-Phase Bone Scan -- 9.8 Gallium-67 Citrate Scintigraphy -- 9.9 Indium-111 Leukocyte Scan -- 9.10 Dual-Isotope Imaging withIn-111-Labelled Leukocytes andTc-99m Sulphur Colloid Bone Marrow Scan -- 9.11 Labelled Leukocyte Scintigraphy withAntigranulocyte Antibody -- 9.12 Positron Emission Tomography with 18F-Fluorodeoxyglucose (18F-FDG/PET) -- 9.13 Conclusion -- References -- 10: Definition ofPeriprosthetic Joint Infection -- 10.1 Algorithm forDiagnosis -- Bibliography -- 11: Differential Diagnosis ofPeriprosthetic Joint Infection -- 11.1 Introduction -- 11.2 Serum Negative Infections -- 11.3 Culture Negative andSlow Growing Organism Infections -- 11.3.1 Inflammatory Arthritis -- 11.3.2 Crystalline Deposit Diseases -- 11.3.3 Hemarthrosis -- 11.3.4 Metal Allergy -- 11.4 Conclusion -- References -- Part V: Treatment of Knee Replacement Infections -- 12: Systemic Antibiotic Therapy -- 12.1 Introduction -- 12.2 Principles andTiming -- 12.3 Debridement, Antibiotics, andImplant Retention (Dair) -- 12.4 One-Stage Exchange -- 12.5 Two-Stage Exchange -- 12.6 Empiric Therapy -- 12.7 Focused Therapy -- 12.7.1 Staphylococcus spp. -- 12.7.2 Streptococcus spp. -- 12.7.3 Enterococcus spp. -- 12.7.4 Gram-Negative Bacteria -- 12.7.5 Anaerobic Bacteria -- 12.7.6 Fungi -- 12.8 Suppressive Therapy -- 12.9 Conclusion -- References -- 13: Local Delivery ofAntibiotic andAntiseptic -- 13.1 Introduction -- 13.2 Antiseptic Intraoperative Lavage -- 13.2.1 Povidone-Iodine Intraoperative Lavage -- 13.2.2 Chlorhexidine Intraoperative Lavage -- 13.3 Antibiotic Local Delivery -- 13.3.1 Antibiotic Powder -- 13.3.2 Nonabsorbable Polymethylmethacrylate (PMMA) Beads

13.3.3 Absorbable Calcium Sulfate Beads -- 13.4 Coated Implant -- 13.4.1 Silver-Coated Implant -- 13.4.2 Iodine-Coated Implant -- 13.4.3 DAC Hydrogel Coated Implant -- 13.5 Conclusions -- References -- 14: Surgical Approaches -- 14.1 Introduction -- 14.2 Skin Incisions -- 14.3 Medial Parapatellar Approach -- 14.4 Insall's Modification toMedial Parapatellar Approach -- 14.5 Lateral Approach -- 14.6 Techniques forExposure ofDifficult TKA -- 14.6.1 Rectus Snip -- 14.6.2 V-Y Quadricepsplasty -- 14.6.3 Tibial Tubercle Osteotomy -- 14.6.4 Femoral Peel -- 14.6.5 Medial Epicondylar Osteotomy -- 14.7 Conclusion -- References -- 15: DAIR (Debridement, Antibiotics, andImplant Retention) fortheTreatment ofPeriprosthetic Joint Infection ofKnee -- 15.1 Introduction -- 15.2 Preoperative Considerations -- 15.2.1 Definition ofPJI andClassification -- 15.2.2 Treatment Algorithm -- 15.2.3 Patients Selection forDAIR -- 15.3 Intraoperative Considerations -- 15.3.1 Surgical Technique -- 15.3.2 Irrigation Protocol -- 15.3.3 Modular Component Exchange -- 15.3.4 Local Antibiotics Administration -- 15.4 Postoperative Consideration -- 15.4.1 Postoperative Antibiotics Regimen -- 15.4.2 Factors Associated withOutcomes ofDair -- References -- 16: One-Stage Exchange Arthroplasty oftheInfected Knee -- 16.1 Introduction -- 16.2 Indications forOne-Stage Exchange Arthroplasty -- 16.3 Endo-Klinik Diagnostic Protocol -- 16.4 Surgical Technique -- 16.4.1 Preoperative Planning andSurgical Approach -- 16.4.2 Radical Debridement andRemoval ofAll Hardware Materials -- 16.4.3 Re-Implantation -- 16.4.4 Postoperative Course -- 16.5 Clinical Results -- 16.6 Conclusions -- References -- 17: Two-Stage Revision Arthroplasty forPeriprosthetic Knee Infection -- 17.1 Introduction -- 17.2 History -- 17.3 Timing forReimplantation

17.4 Non-Articulating Vs. Articulating Spacers -- 17.5 Local Antibiotics -- 17.6 Systemic Antimicrobial Therapy -- 17.7 Surgical Tips andTricks -- 17.8 Cement Spacer Exchange -- 17.9 Cement Spacer Irrigation andDebridement -- 17.10 Infected Bilateral Knee Arthroplasties -- 17.11 Conclusion -- References -- 18: The Use ofStatic Spacers inPeriprosthetic Knee Infections -- 18.1 Introduction -- 18.2 General Spacer Properties -- 18.2.1 Mechanical Properties -- 18.2.2 Anti-Microbial Properties -- 18.2.3 Two Types ofCement Spacer -- 18.3 Indications foraStatic Spacer inTKA Infections -- 18.4 Surgical Technique -- 18.5 Results andComplications ofStatic Spacers (Table 18.1) -- 18.5.1 Rate ofInfection Eradication -- 18.5.2 Range ofMotion -- 18.5.3 Knee Society Score (KSS) andHospital forSpecial Surgery Knee Score (HSS) -- 18.5.4 Rate ofSurgical Soft Tissue Release -- 18.5.5 Complications -- 18.6 Conclusion -- References -- 19: Dynamic (Mobile) Spacers inInfected Total Knee Arthroplasty -- 19.1 Introduction -- 19.2 Types andProperties ofDynamic Spacers -- 19.3 Advantages ofDynamic Spacers -- 19.4 Contraindication ofDynamic Spacers -- 19.5 Antibiotic Properties ofDynamic Spacers -- 19.6 Interim Period Length andMobilization withDynamic Spacers -- 19.6.1 Length oftheInterim -- 19.6.2 Mobility During theInterim -- 19.7 Complications Related totheUse ofDynamic Spacers -- 19.8 Conclusion -- References -- 20: Knee Arthrodesis -- 20.1 Introduction -- 20.2 Indications andContraindications forArthrodesis -- 20.3 Limitations ofKnee Arthrodesis -- 20.4 Principles ofKnee Arthrodesis -- 20.4.1 Host Optimisation -- 20.4.2 Knee Fusion Position -- 20.4.3 One-Stage Versus Two-Stage Arthrodesis -- 20.5 Techniques forArthrodesis -- 20.5.1 External Fixator -- 20.5.2 Fusion Nail

20.5.3 Combined Surgical Techniques