Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications

Introduction:

Aging and effect of antiretroviral therapy on bone mass could increase the risk of femoral neck fractures (FNF) in HIV patient. The aim of this study was specifically to determine whether intracapsular FNF in HIV-positive patients are more prone to short-term post-operative complications than similar fractures occurring in HIV-negative patients.

Materials and methods:

A group of 25 HIV-positive patients with intracapsular FNF were enrolled and matched to HIV-negative patient with similar fractures according to gender, age, a modified Charlson Comorbidity Index (CCI), fracture classification, surgical treatment and time interval between fracture event and surgery. For each group, length of stay, surgical time, early clinical outcomes and short-term surgical and medical complications were compared to determine the impact on the early outcome.

Results:

At the time of the fracture occurrence, 56% of HIV-positive patients were on antiretroviral therapy and 12% started with therapy in the perioperative period. At three months follow-up, there were no statistically significant differences between the two study groups in length of stay, Harris hip score and total number of early complications. However, a statistically significant increase in urinary tract infections and longer surgical time using hip sliding screw fixation were seen in the HIV-positive group. The poorest post-operative result was seen in a patient who failed to adequately adhere to the HIV therapy protocol.

Conclusions:

This study failed to show any statistically significant increase in short-term complications or worse clinical outcomes for intracapsular FNF in HIV-positive patients compared to HIV-negative patients to recommend their treatment in dedicated centres.

Postoperative outcomes in total hip arthroplasty following femoral head avascular necrosis in HIV-positive patients

Background:

Few clinical studies have been published reporting the clinical outcomes of total hip replacement (THA) in HIV-positive patients affected by femoral head avascular necrosis (AVN) often with controversial results and often without any correlation with the immunological patient status. Our study aim is to retrospectively review the outcome of a HIV-positive patient series.

Material and Methods:

24 THAs perfomed between 2007 and 2017 were assessed in the study. All patients have been classified with Charlson Comorbidity Index (CCI) and the CDC (Center for Disease Control and Prevention) HIV classification. At the latest follow-up each patient have been evaluated using Harris Hip Score (HHS), WOMAC score, a numerical pain rating scale (NRS) and procedure-related complications were collected.

Results:

At a mean mean follow up of 96,41 months the mean WOMAC score was 91,66 and the mean Harris Hip Score was 86,77 with excellent results in 18 hips, good in 1 and poor in the 5. Post-operative complications were reported in 7 hips, 3 patients developed a periprosthetic joint infection (PJI) in patients with low CD4+ count and history of intravenous drug consumption.

Conclusion:

We registered a good outcome in HIV patient with femoral head AVN treated with Total Hip replacement. However, we reported a significant increase in complications and revision rate especially referred to PJI, in patient with history of intravenous drug consumption and low CD4+ count. The authors advocate further prospective multicentric studies with larger population in the future. (www.actabiomedica.it9

Septic arthritis following joint injections: a 17 years retrospective study in an Academic General Hospital

BACKGROUND

Septic arthritis following intra-articular infiltrations is an uncommon devastating complication correlated  to high costs for the health service and often to poor outcomes. The purpose of this study is to assess a 17-years experience in a single academic multispecialist hospital managing this uncommon complication in Orthopaedic practice.

METHODS

Patients with diagnosis of septic arthritis following joint injections treated in our hospital from January 2002 to December 2019 were included in the study. Clinical and demographic data, pathogens, injected agent, conservative/surgical treatments were reviewed. Patient were classified according to the ore operative Charlson Comorbidity Index (CCI) and the Cierny-Mader Classification(CMC). Furthermore follow-up outcome and time occurred to infection eradication were registered.

RESULTS

We included in the study 11 patients with a median age of 74 years old (IQR= 61.5 - 79). The median CCI was 3  (IQR= 2 - 5) and the majority of patients belong to CMC = B class. Septic arthritis occurred mainly following corticosteroids injections and more frequently involving knees. The pathogen more often isolated was Staphylococcus aureus. Five (45%) patients referred an history of multiple intrarticular injections. 7 patients (64%) had a complete resolution following an arthroscopic debridement, 4 (36%) patients underwent to a 2-stage replacement and one of them hesitated in an arthrodesis because of a recurrent periprothesic joint infection and extensor apparatus insufficiency.

CONCLUSION

The authors observed a potential increased risk of septic arthritis following joint injection in patients with history of multiple injections and poor health/immunological conditions. They recommend an early arthroscopic debridement as the treatment of choice especially in septic knees  performed in a multispecialist dedicated center.

Clinical outcome before and after COVID-19 quarantine in patients affect of knee and hip osteoarthritis

BACKGROUND

The emergency caused by COVID-19 Pandemia has resulted in a complete suspension and consequent delay of common planned surgery such total hip replacement in patients affect by osteoarthritis. At the same time, the issue of the quarantine imposed changes to the normal lifestyle of these patients. The purpose of our study is to evaluate how the presence of these two factors affect the quality of live of patients living in the Italian red zone.

METHODS

From outpatient pre-operative assessment we collect data about: demographic data, WOMAC score, NRS (Numeric rating scale 0-10), PCS SF12 and MCS SF12 score. Selected patients were therefore contacted by telephone call and re-assess using the same score. In addition, patients were asked if they intended to undergo the planned surgery again despite the current emergency Results:  14 patient have been recruited for the study. Male/female ration was 10/4, mean age was 70 years. Pre operative outpatient assessment mean WOMAC score was 44,86 (SD ± 8,52) , mean NRS was 8,07 (SD ± 1,33), PCS SF12 was  30,33 (SD ± 5,0) and MCS SF12 was 40,95 (SD ± 3,51).  At re-evalutation the mean WOMAC score was 32,86 (SD ± 17,88) , mean NRS was 5,79 (SD ± 3,66), PCS SF12 was  39,9 (SD ± 3,70) and MCS SF12 was 50,14 (SD ± 6,86) Conclusion:  The exceptionale pandemic from Covid-19 has profoundly changed our lifestyle, impacting normal daily activities but also on regular surgical activity in patients affected by osteoarthritis. Our study suggested that the lifestyle changes imposed by the situation led to an improvement of clinical score. This shows how an exceptional event can affect many aspects of daily life.

Humeral head necrosis associated to shaft non-union with massive bone loss: a case report

Humeral non-union is a rare complication in shaft fractures, as well as humeral head necrosis is a possible complication in fracture involving the proximal third especially in four-part fractures. The presence of head osteonecrosis and diaphyseal non-union in the same arm represents a formidable challenge for an orthopaedic surgeon. We could not find any similar report in the literature dealing with this issue thus far. We present a case of a 65 years old woman referred to our hospital being affected by an atrophic humeral diaphyseal non-union with a massive bone loss (>10cm) associated to a humeral head osteonecrosis following a previous surgical procedures with a clear loosening of the hardware. At our institution,she was treated with hardware removal and insertion of a diaphyseal antibiotic spacer with Gentamycin for 2 months suspecting an active septic process at the union site despite negative cultural exams. Finally, she was treated with a cemented modular humeral megaprosthesis. At 20 months follow up, the patient, despite a reduced shoulder range of motion, referred to a pain-free recovery to an almost normal lifestyle, including car driving with no major disturbances. This case suggests that, in extreme selected cases following several failed treatments, megaprosthesis can represent a viable solution, especially in huge bone loss associated to joint degeneration, to ensure an acceptable return to a normal lifestyle.

Non artheritic bilateral anterior ischaemic optic neuropathy (NAION) as devastating complication following Total Hip Arthroplasty: a case report

Introduction: Postoperative vision loss (PVL) is an extremely rare complication following major surgical procedures. Patients with systemic hypertension, diabetes, coronary diseases and smokers are generally predisposed to this complication. More frequently, it is caused by ischemic optic neuropathy (ION), central retinal artery occlusion or retinal vein occlusion. Rare cases of unilateral PVL following total joint arthroplasty surgery have been recently described in literature. Case report: This case report describes the first reported bilateral non-arteritic anterior ischemic optic neuropathy (NAION), which occurred 3 days following a total hip arthroplasty with a consequent post-operative hypotension. Conclusions: Orthopedic surgeons should be aware that in hip joint replacement procedures, selected patients present an higher risk of ION following intra/postoperative hypotension and prolonged surgical times. (www.actabiomedica.it)

Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up

INTRODUCTION

The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft.

METHODS

The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation.

RESULTS

At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B). The difference was statistically significant (p < 0.05).

CONCLUSIONS

Femoral press-fit fixation of bone- patellar tendon- bone autograft provides stable fixation at low cost, it ensures unlimited bone-to-bone healing and high primary stability, avoiding the disadvantages of hardware and the need for removal in case of revision.

A flat all-polyethylene tibial component in medial unicompartmental knee arthroplasty: a long-term study

PURPOSE

The aim of this study is to present the clinical and radiological results of a cemented unicompartmental knee arthroplasty (UKA) using a flat all-polyethylene tibial component at long-term follow-up, in a homogeneous group of patients with medial femoro-tibial knee arthritis.

METHODS

The study group included 53 knees in 51 patients who were treated between January 1998 and November 1999 using a flat all-polyethylene tibial component. The same surgical technique was used for all patients. Inclusion criteria included a diagnosis of atraumatic arthritis, pre-operative flexion greater than 100° with no flexion deformity, a varus deformity of less than 10°, and a body mass index (BMI) less than 35. A neutral mechanical axis was considered the end-point in all interventions. The patients were assessed clinically using the International Knee Society (IKS) and the functional scores at follow-up. Plain radiographs were used to determine the alignment of the mechanical axis at 5, 10 and 14.7-year follow-up. A radiographic analysis of loosening, based on the method described by the IKS, was performed and the degree of arthritic progression in the non-resurfaced compartment was also assessed.

RESULTS

At latest follow-up five patients had died and the data for three patients had not been collected. At final review four knees had undergone revision surgery and a further patient had declined a recommended revision TKA. The main indication for revision surgery was progressive aseptic loosening of the tibial component in female patients. No revisions were required because of arthritic progression in the lateral compartment. Over time the clinical outcomes did not show statistically significant differences. There was a significant worsening of the mechanical axis at the last follow-up compared with the results at five and ten year review.

CONCLUSIONS

This study demonstrated that, in primary arthritis involving the medial femoro-tibial compartment, UKA using a flat all-polyethylene component could be considered an effective surgical option. Attention should be paid to progressive worsening of the mechanical axis over time associated with progressive radiolucency especially in female patients.

LEVEL OF EVIDENCE

IV.

Post traumatic knee arthritis: navigated total knee replacement without hardware removal

BACKGROUND

The Authors present the results of a series of navigated total knee replacements (TKR) without hardware removal in patients with post-traumatic arthritis following femoral fractures. The purpose of the paper was to determine the effectiveness of computer-assisted TKR in these patients compared to routine primary implants.

METHODS

Sixteen patients with post-traumatic knee arthritis following a distal femoral fracture and retained hardware were included in the study (group I). Patients in the study group were matched with patients who had undergone a computer navigated TKR using the same implant and software (group II). The indication for TKR in all group II patients was atraumatic arthritis and surgery was performed in the same period as the study group. Patients were matched for age, gender, pre-operative range of motion, severity of arthritis pre-operatively, type and grade of deformity and implant features.

RESULTS

There were no statistically significant differences in surgical time, hospital staying or intra-operative and post-operative complications between the two study groups. At the latest follow-up no statistically significant difference was seen for the Knee Society Score and WOMAC indices. Implant alignment and radiological parameters were similar in both groups.

CONCLUSIONS

This study demonstrated that post-traumatic knee arthritis following prior distal femoral fracture can be safely managed using a computer navigated TKR without hardware removal. Comparison between this patient group and a matched group with atraumatic arthritis showed similar post-operative results and complication rates.

LEVEL OF EVIDENCE

III.

Computer-assisted unicompartmental knee arthroplasty using dedicated software versus a conventional technique

PURPOSE

The aim of this study was to retrospectively compare the results of two matched-paired groups of patients who had undergone a medial unicompartmental knee arthroplasty (UKA) performed using either a conventional or a non-image-guided navigation technique specifically designed for unicompartmental prosthesis implantation.

METHODS

Thirty-one patients with isolated medial-compartment knee arthritis who underwent an isolated navigated UKA were included in the study (group A) and matched with patients who had undergone a conventional medial UKA (group B). The same inclusion criteria were used for both groups. At a minimum of six months, all patients were clinically assessed using the Knee Society Score (KSS) and the Western Ontario and McMaster Osteoarthritis Index (WOMAC) index. Radiographically, the frontal-femoral-component angle, the frontal-tibial-component angle, the hip-knee-ankle angle and the sagittal orientation of components (slopes) were evaluated. Complications related to the implantation technique, length of hospital stay and surgical time were compared.

RESULTS

At the latest follow-up, no statistically significant differences were seen in the KSS, function scores and WOMAC index between groups. Patients in group B had a statistically significant shorter mean surgical time. Tibial coronal and sagittal alignments were statistically better in the navigated group, with five cases of outliers in the conventional alignment technique group. Postoperative mechanical axis was statistically better aligned in the navigated group, with two cases of overcorrection from varus to valgus in group B. No differences in length of hospital stay or complications related to implantation technique were seen between groups.

CONCLUSION

This study shows that a specifically designed UKA-dedicated navigation system results in better implant alignment in UKA surgery. Whether this improved alignment results in better clinical results in the long term has yet to be proven.

Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee arthrodesis

Background

Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella.

Case presentation

We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°.

Conclusions

We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes.

An uncommon cause of cemented unicompartmental knee arthroplasty failure: fracture of metallic components

PURPOSE

Despite good overall clinical results, unicompartmental knee replacements (UKR) are not without their problems and failures have been reported. The most common causes of UKR failure are component loosening, poor patient selection, poor surgical technique, polyethylene wear and progression of arthritis in other compartments. The purpose of this study is to present a series of atraumatic fractures of metallic components in a UKR treated in a single orthopaedic centre.

METHOD

Since 1999, 121 failed unicompartmental knee arthroplasties have been referred to our centre. In six of these, atraumatic breakage of a metal component in the cemented UKR was seen and included in this study. Pre-operative alignment, BMI and implant longevity were documented. The femoral implant failed in 4 patients and the tibial implant in a further 2.

RESULTS

All the femoral implant fractures occurred within 3 years of UKR surgery (mean: 22.2 months, SD: 10.6 months). Tibial implant breakage occurred at a mean of 8.5 years (SD: 2.4 months) following UKR. All patients were treated with conversion to a navigated total knee replacement. A primary total knee arthroplasty was used in all cases with one patient requiring a tibial component incorporating a wedge and stem following breakage of the original UKR tibial implant.

CONCLUSION

Fracture of the metallic components is a potential cause of failure of unicompartmental knee arthroplasty. In our experience, the incidence of this complication was 4.9 % of all UKR failures. Patients with a BMI greater than 30 and a progressive deterioration in limb alignment were at greater risk.

Computer-assisted total knee arthroplasty after prior femoral fracture without hardware removal

This study presents a consecutive series of patients who underwent total knee arthroplasty (TKA) after prior distal femoral fracture without hardware removal. The purpose of this study was to determine the effectiveness of computer-assisted TKA in patients with posttraumatic arthritis, specifically those with retained hardware after prior distal femoral fracture. The study group included a consecutive series of 16 patients who had developed posttraumatic knee arthritis after a distal femoral fracture with retention of hardware (group A). Patients in the study group were matched with patients who had undergone a computer-assisted TKA using the same implant and software (group B). The indication for TKA in all group B patients was atraumatic arthritis, and surgery was performed during the same period as that in the study group. Patients were matched for age, sex, preoperative range of motion, preoperative severity of arthritis, type and grade of deformity, and implant features. No statistically significant differences existed between the 2 study groups in terms of operative time, duration of hospital stay, or intra- and postoperative complications. At last follow-up, no statistically significant differences existed in Knee Society Scores and Western Ontario and McMaster Universities Arthritis Index scores. Implant alignment and radiological parameters were similar in both groups. This study demonstrated that posttraumatic knee arthritis after prior distal femoral fracture can be safely managed using a computer-assisted TKA without hardware removal. Comparison between the study group and a matched group with atraumatic arthritis showed similar postoperative results and complication rates.

Does computer-assisted surgery benefit leg length restoration in total hip replacement? Navigation versus conventional freehand

Leg length discrepancy following total hip replacement (THR) can contribute to poor hip function. Abnormal gait, pain, neurological disturbance and patient dissatisfaction have all been described as a result of leg length inequality after THR. The purpose of this study was to determine whether the use of computer navigation in THR can improve limb length restoration and early clinical outcomes. We performed a matched-pair study comparing 48 computer-assisted THR with 48 THRs performed using a traditional freehand alignment method. The same implant with a straight non-modular femoral stem was used in all cases. The navigation system used allowed the surgeon to monitor both acetabular cup placement and all the phases of femoral stem implantation including rasping. Patients were matched for age, sex, arthritis level, pre-operative diagnosis and pre-operative leg length discrepancy. At a minimum follow-up of six months, limb length discrepancy was measured using digital radiographs and a standardised protocol. The number of patients with a residual discrepancy of 10 mm or more and/or a post-operative over-lengthening were measured. The clinical outcome was evaluated using both the Harris Hip Score and the normalised Western Ontario and McMaster Universities (WOMAC) Arthritis Index. Restoration of limb length was significantly better in the computer-assisted THR group. The number of patients with a residual limb length discrepancy greater than 10 mm and/or a post-operative over-lengthening was significantly lower. No significant difference in the Harris Hip Score or normalised WOMAC Arthritis Index was seen between the two groups. The surgical time was significantly longer in the computer-assisted THR group. No post-operative dislocations were seen.

Relationship between cutting errors and learning curve in computer-assisted total knee replacement

Computer-assisted total knee replacement (TKR) has been shown to improve radiographic alignment. Continuous feedback from the navigation system allows accurate adjustment of the bone cuts, thus reducing errors. The aim of this study was to determine the impact of experience both with computer navigation and knee replacement surgery on the frequency of errors in intraoperative bone cuts and implant alignment. Three homogeneous patient groups undergoing computer assisted TKR were included in the study. Each group was treated by one of three surgeons with varying experience in computer-aided and knee replacement surgery. Surgeon A had extensive experience in knee replacement and computer-assisted surgery. Surgeon B was an experienced knee replacement surgeon. A general orthopaedic surgeon with limited knee replacement surgery experience performed all surgeries in group C. The cutting errors and the number of re-cuts were determined intraoperatively. The complications and mean surgical time were collected for each group. The postoperative frontal femoral component angle, frontal tibial component angle, hip-knee-ankle angle and component slopes were evaluated. The results showed that the number of cutting errors were lowest for TKR performed by the surgeon with experience in navigation. This difference was statistically significant when compared to the general orthopaedic surgeon. A statistically significant superior result was achieved in final mechanical axis alignment for the surgeon experienced in computer-guided surgery compared to the other two groups (179.3 degrees compared to 178.9 degrees and 178.1 degrees ). However, the total number of outliers was similar, with no statistically significant differences among the three surgeons. Experience with navigation significantly reduced the surgical time.

Intra-operative tibial fracture during computer assisted total knee replacement: a case report

Recently computer-assisted joint replacement surgery has been introduced to improve implant alignment. To date no intra-operative fractures have been reported related to the insertion of the navigation trackers used in this technique. The authors present the case of a 76-year-old man who sustained an intra-operative tibial fracture at the site of insertion of the navigation tracker during computer assisted total knee replacement.

Intertrochanteric fracture of an arthrodesed hip

We report the case of a 74-year-old woman who sustained an intertrochanteric fracture of the femoral neck in a previously arthrodesed hip. The hip arthrodesis had been performed 53 years earlier to treat septic arthritis. The fracture was treated successfully using a double-plating technique with 4.5 mm titanium reconstruction plates.

Grafting of tibial bone defects in knee replacement using Norian skeletal repair system

INTRODUCTION

The authors have been using Norian skeletal repair system (SRS) to repair cancellous bone defects in knee replacements since 1999. Norian SRS is injectable, biocompatible calcium phosphate cement with a high mechanical strength. This product is similar to the mineral phase of bone and should undergo gradual remodeling with time. We present our experience with this bone substitute in a total of 13 knee replacement surgeries.

MATERIALS AND METHODS

This included three unicompartmental knee replacements (UKR), two bilateral UKR following tibial plateau fractures, five revisions of UKR to total knee replacements (TKR), two TKR revisions and one hinged knee prosthesis for significant deformity. Full weight bearing was permitted as soon as tolerated in all patients. Patients were evaluated at the latest follow-up using both the Knee Society Score (KSS) and GIUM (Italian UKR Users Group) knee scores.

RESULTS

At the latest follow-up, no poor results were seen with an improvement between pre-operative and post-operative knee scores in all cases. There was no evidence of bone loss or post-operative deformity. Complete compound resorption was seen in the first 4 cases.

CONCLUSIONS

The authors state that Norian SRS is a practical alternative as bone grafting in knee replacement surgery for type 1 and 2 bone defects.

Unicompartmental versus computer-assisted total knee replacement for medial compartment knee arthritis: a matched paired study

Patients older than 60 with unicompartmental knee arthritis can be treated with total or unicompartmental knee replacement. The aim of this study was to compare the results of matched paired groups of patients with isolated medial compartment knee arthritis replaced with either UKR (group A) or computer-assisted TKR (group B). The results included 68 knees at a minimum follow-up of 3 years. All patients had a varus deformity no greater than 8 masculine and a BMI lower than 30. Patients were matched in terms of preoperative arthritis severity, age, gender and preoperative range of motion. In the computer-assisted TKR group, all the implants were positioned within 4 masculine of the correct hip-knee-ankle angle and frontal tibial component angle. The surgical time and hospital stay were statistically longer in the CA TKR group. During the study no implant required revision. The results showed higher scores for a UKR in the treatment of isolated primary unicompartmental knee arthritis in patients older than 60 compared to a computer-assisted TKR. In this study a computer-assisted alignment system for TKR with optimal implant positioning did not produce equivalent clinical results compared to a UKR, but did increase the financial costs.

Treatment of the late sequelae of septic arthritis of the hip

Numerous salvage procedures have been proposed for the treatment of late sequelae of septic arthritis of the hip. Despite this, there are no reports in the literature discussing treatment with simultaneous hip reconstruction and femoral lengthening using the hybrid advanced Ilizarov method. The authors reviewed their experience with this technique, and present 15 patients treated between 1982 and 1997. The average age of the patients was 21.1 years and the average limb length discrepancy was 6.5 cm. All the hips were classified according to the classification of Choi et al. The time the external fixator was worn was 225.5 days and the average followup was 108 months. The results were classified based on pain relief, residual deformity, range of motion, Trendelenburg sign, and limb length discrepancy. Ten patients had a good or excellent result, three patients had a fair result, and only two patients had a poor result. Major complications included a common peroneal nerve palsy in one patient, loss of angulation of the proximal femoral osteotomy in two patients, and a mild knee subluxation in three patients all of whom responded to treatment. At the latest followup, 13 patients were satisfied with the treatment, all had returned to their previous occupations, and no patient had a total hip arthroplasty.

The Ilizarov method for failed knee arthrodesis following septic TKR

Knee arthrodesis is a well-recognized salvage procedure in patients with infected total knee arthroplasties. If a fusion is achieved, it offers the opportunity for a stable lower limb and eradication of infection, but at the expense of knee motion. However, knee arthrodesis in this setting may be difficult to achieve because of poor bone stock, persistent infection, soft tissue compromise, and often the poor general health of the patient. We report two cases of failed knee arthrodesis following periprosthetic infection where a fusion was successfully achieved with open debridement and a hybrid advanced Ilizarov fixator.