Sequential Bilateral Prosthetic Knee Infections Managed with Divergent Surgical Strategies: A Case Report.

Introduction: Prosthetic joint infection (PJI) is one of the most serious complications of total knee arthroplasty (TKA). Bilateral sequential PJI is rare and presents unique therapeutic challenges. Case Report: This case reports a 68-year-old male with diabetes, hypertension, and peripheral vascular disease who developed infections in both knee prostheses. His left knee was treated with debridement, prosthesis removal, and spacer insertion, ultimately resulting in arthrodesis. A few months later, his right prosthesis became infected. During the first-stage revision arthroplasty, the components were removed, and a spacer was inserted. His clinical course was complicated by Clostridioides difficile colitis secondary to prolonged antibiotic therapy. Following stabilization, a second-stage revision TKA was performed, achieving full extension and 120° of flexion intraoperatively. The patient subsequently began rehabilitation at home. Conclusion: This case highlights the divergent outcomes of sequential bilateral PJI and underscores the need for individualized surgical decision-making, antimicrobial stewardship, and multidisciplinary care.