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Mercurio M, Gasparini G, Cofano E, Zappia A, Familiari F, Galasso O. Knee Arthrodesis for Periprosthetic Knee Infection: Fusion Rate, Complications, and Limb Salvage-A Systematic Review. Healthcare (Basel) 2024; 12:804. [PMID: 38610226 PMCID: PMC11011444 DOI: 10.3390/healthcare12070804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
The aim of this systematic review was to investigate the outcomes of knee arthrodesis (KA) after periprosthetic joint infection (PJI) of the knee. Differences in clinical outcomes and complication rates among the intramedullary nailing (IMN), external fixation (EF), and compression plating (CP) procedures were compared. A total of 23 studies were included. Demographics, microbiological data, types of implants, surgical techniques with complications, reoperations, fusion, and amputation rates were reported. A total of 787 patients were evaluated, of whom 601 (76.4%), 166 (21%), and 19 (2.4%) underwent IMN, EF, and CP, respectively. The most common causative pathogen was coagulase-negative Staphylococcus (CNS). Fusion occurred in 71.9%, 78.8%, and 92.3% of the patients after IMN, EF, and CP, respectively, and no statistically significant difference was found. Reinfection rates were 14.6%, 15.1%, and 10.5% after IMN, EF, and CP, respectively, and no statistically significant difference was found. Conversion to amputation occurred in 4.3%, 5%, and 15.8% of patients after IMN, EF, and CP, respectively; there was a higher rate after CP than after EF. The IMN technique is the most common option used for managing PJI with KA. No differences in terms of fusion, reinfection, or conversion-to-amputation rates were reported between IMN and EF. CP is rarely used, and the high amputation rate represents an important limitation of this technique.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (M.M.); (G.G.); (A.Z.); (F.F.); (O.G.)
- Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (M.M.); (G.G.); (A.Z.); (F.F.); (O.G.)
- Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (M.M.); (G.G.); (A.Z.); (F.F.); (O.G.)
| | - Andrea Zappia
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (M.M.); (G.G.); (A.Z.); (F.F.); (O.G.)
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (M.M.); (G.G.); (A.Z.); (F.F.); (O.G.)
- Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (M.M.); (G.G.); (A.Z.); (F.F.); (O.G.)
- Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy
- Clinica Ortopedica Department, San Giovanni di Dio e Ruggi D’Aragona University Hospital, 84100 Salerno, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy
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Coden G, Bartashevskyy M, Berliner Z, Niu R, Freccero D, Bono J, Abdeen A, Smith EL. Modular Knee Arthrodesis as Definitive Treatment for Periprosthetic Infection, Bone Loss, and Failure of the Extensor Mechanism After Total Knee Arthroplasty. Arthroplast Today 2024; 25:101261. [PMID: 38269067 PMCID: PMC10805633 DOI: 10.1016/j.artd.2023.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 01/26/2024] Open
Abstract
Background Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) can result in bone and soft-tissue loss, leg length discrepancies, and dysfunctional extensor mechanisms. While above-knee amputation (AKA) is an established salvage treatment, modular knee arthrodesis (MKA) is a viable option that provides rigid stability and maintains leg length even in patients with severe bone and soft-tissue loss. We sought to report the outcomes of patients with an MKA as the definitive treatment. Methods We retrospectively reviewed 8 patients implanted with an MKA at 2 institutions between 2016 and 2022. The mean age was 69.63 years, and 50.0% of patients were women. All patients were indicated for conversion to an MKA as the definitive treatment in the setting of treated chronic PJI after TKA, severe bone loss, and failure of the extensor mechanism not amenable to repair. Medical records and radiographs were reviewed. Results No patients required incision and drainage or exchange of their MKA for PJI at mean 2-year follow-up. One patient required 2 revisions for mechanical failure of his implant at 5.0 and 6.4 years postoperatively. Conclusions MKA is a viable permanent alternative to AKA for patients with treated chronic PJI and dysfunctional extensor mechanism after TKA. The procedure restores leg lengths in the setting of severe bone and soft-tissue loss, therefore allowing patients to ambulate independently. Still, surgeons should be aware of the potential for mechanical failure requiring revision.
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Affiliation(s)
- Gloria Coden
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | | | - Zachary Berliner
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - Ruijia Niu
- Department of Research, New England Baptist Hospital, Boston, MA, USA
| | - David Freccero
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - James Bono
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Ayesha Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA
| | - Eric L. Smith
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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Büyükdoğan K, Öztürkmen Y, Goker B, Oral M, Atay T, Özkan K, Çağlar Ö, Ayvaz M. Early results of a novel modular knee arthrodesis implant after uncontrolled periprosthetic knee joint infection. BMC Musculoskelet Disord 2023; 24:889. [PMID: 37968710 PMCID: PMC10648648 DOI: 10.1186/s12891-023-07016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
AIM The aim of this study is to evaluate the functional outcomes and complications after non-fusion knee arthrodesis with a modular segmental intramedullary implant used for infected total knee arthroplasty revisions. METHODS A retrospective review of the patients who had been surgically treated with a modular intramedullary arthrodesis implant for recurrent infection after revision TKA between January 2016 and February 2020 were included. The indications for arthrodesis were failed infected TKA with massive bone loss, deficient extensor mechanism and poor soft tissue coverage that precluded joint reconstruction with revision TKA implants. Clinical outcomes were assesed with visual analogue scale for pain (pVAS), Oxford knee score (OKS) and 12-item short form survey (SF-12). Full-length radiographs were used to verify limb length discrepancies (LLD). RESULTS Fourteen patients (4 male and 10 female) patients with a mean age of 69.3 (range, 59 to 81) years at time of surgery were available for final follow-up at a mean of 28.8 months (range, 24-35 months). All clinical outcome scores improved at the final follow-up (pVAS, 8.5 to 2.6, p = .01; OKS, 12.6 to 33.8, p = .02; SF-12 physical, 22.9 to 32.1, p = .01 and SF-12 mental, 27.7 to 40.2, p = .01). The mean LLD was 1.0 cm (range, + 15 - 2.3 cm). Re-infection was detected in three patients (21.4%). Two patients were managed with suppressive antibiotic treatment and a third patient required repeat 2-stage revision procedure. In one patient, a periprosthetic femur fracture was observed and treated with plate osteosynthesis. CONCLUSION Uncontrolled infection after total knee arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail and satisfactory functional results can be obtained. LEVEL OF EVIDENCE Level 4, Retrospective cohort study.
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Affiliation(s)
- Kadir Büyükdoğan
- Department of Orthopedic Surgery, Güven Hospital, Şimşek Sokak, No: 29, A.Ayrancı, Ankara, Turkey.
| | - Yusuf Öztürkmen
- Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Barlas Goker
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Melih Oral
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tolga Atay
- Department of Orthopedics and Traumatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Korhan Özkan
- Orthopedics and Traumatology Department, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ömür Çağlar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ayvaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Savvidou OD, Kaspiris A, Goumenos S, Trikoupis I, Melissaridou D, Kalogeropoulos A, Serenidis D, Georgoulis JD, Lianou I, Koulouvaris P, Papagelopoulos PJ. Knee Arthrodesis with a Modular Silver-Coated Endoprosthesis for Infected Total Knee Arthroplasty with Extensive Bone Loss: A Retrospective Case-Series Study. J Clin Med 2023; 12:jcm12103600. [PMID: 37240706 DOI: 10.3390/jcm12103600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. METHODS Eight patients with a modular silver-coated arthrodesis implant after failed exchange arthroplasty for infection, were retrospectively reviewed. All patients had significant bone loss, while 5 displayed extensor tendon deficiency. Survivorship, complications, leg length discrepancy, median Visual Analogue Scale (VAS) and Oxford Knee score (OKS) were evaluated. RESULTS The median follow up was 32 months (range 24-59 months). The survivorship rate of the prosthesis was 86% during the minimum time of follow up of 24 months. In one patient recurrence of the infection was observed and above-knee amputation was performed. The median postoperative leg length discrepancy was 2.07 ± 0.67 cm. Patients were able to ambulate with mild or no pain. The median VAS and OKS was 2.14 ± 0.9 and 34.7 ± 9.3, respectively. CONCLUSIONS The results of our study demonstrated that knee arthrodesis with a silver coated arthrodesis implant, performed for persistent PJI in patients with significant bone loss and extensor tendon deficit, provided a stable construct, allowed eradication of infection and was associated with good functional outcome.
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Affiliation(s)
- Olga D Savvidou
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Patras, 26504 Patras, Greece
| | - Stavros Goumenos
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioannis Trikoupis
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitra Melissaridou
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | | | - Dimitris Serenidis
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Jim-Dimitris Georgoulis
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Ioanna Lianou
- Department of Orthopaedics, Rion University Hospital University of Patras, 26504 Patras, Greece
| | - Panagiotis Koulouvaris
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panayiotis J Papagelopoulos
- Medical School, First Department of Orthopedics, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Miralles-Muñoz FA, Pineda-Salazar M, Rubio-Morales M, González-Parreño S, Ruiz-Lozano M, Lizaur-Utrilla A. Similar outcomes of constrained condylar knee and rotating hinge prosthesis in revision surgery for extension instability after primary total knee arthroplasty. Orthop Traumatol Surg Res 2022; 108:103265. [PMID: 35257946 DOI: 10.1016/j.otsr.2022.103265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/08/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability is one of the most common reasons for total knee arthroplasty (TKA) failure. Constrained prosthesis can be used for significant ligamentous laxity, but there is not much evidence on the appropriate level of restriction for unstable varus-valgus TKA. The objective of this study was to compare the outcome and survival at a minimum follow-up of five years between rotating hinge knee prosthesis (RHK) and constrained condylar knee prosthesis (CCK) for extension instability following primary TKA. HYPOTHESIS For symptomatic extension instability after primary TKA, good functional outcomes and survival can be achieved with both designs. MATERIAL AND METHODS Consecutive patients with unstable primary TKA who underwent revision with either RHK (n=34) or CCK (n=30) were retrospectively compared. Assessments were performed by the Knee Society Scores (KSS), and visual analogue scales (VAS) for pain and patient satisfaction. Radiological evaluation was made. Complications and re-operations were analyzed. RESULTS Mean post-operative follow-up was 10.3 (range 5-16) years for both groups. At the final follow-up, there was no significant difference between groups in the KSS-knee (p=0.228) or KSS-function (p=0.324) score, VAS-pain (p=0.563), VAS-satisfaction (p=0.780), major complication rate (p=0.194), or TKA survival at 10 years (p=0.091). CONCLUSION The present study showed comparable good functional outcomes and survival at long-term between RHK and CCK arthroplasties. Both designs can be recommended for revision of total knee arthroplasty with symptomatic extension instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain.
| | - Manuel Pineda-Salazar
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Marta Rubio-Morales
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Santiago González-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Matías Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda 03600, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
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Benhenneda R, Le Nail LR, Druon J, Saad M, Rosset P, Samargandi R. Knee arthrodesis using a compression clamp and a single-plane external fixator to treat infection. Orthop Traumatol Surg Res 2022; 108:103330. [PMID: 35597544 DOI: 10.1016/j.otsr.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to infection is left in situ. However, the fusion rate is limited. Use of a device that applies compression in the coronal plane has been suggested in combination with sagittal external fixation to increase the fusion rate but has not been the focus of published studies. The objectives of this retrospective study were to determine: 1) the fusion rate and, 2) the rate of infection eradication. HYPOTHESIS Knee arthrodesis using an external fixator and a compression clamp provides higher fusion rates compared to reports of external fixation without compression. MATERIAL AND METHODS We retrospectively studied 30 patients who underwent knee arthrodesis using external fixation and a compression clamp. The reason for arthrodesis was recurrent infection after total knee arthroplasty in 18 patients and septic arthritis in 12 patients. There were 16 females and 14 males with a mean age of 66.0±11.6 years (range, 30-83 years). Mean follow-up was 42.5±23.6 months (range, 24-106 months). RESULTS Fusion was achieved in 25 (83%) patients, after a mean of 7.5 months (range, 6-12 months). Of the 8 patients with severe bone loss (≤25% bone contact), 4 experienced non-union, compared to 1 of the 22 patients whose bone loss was moderate or mild (50% and >50% bone contact, respectively) (p=0.01). After at least 2 years of follow-up, the infection was eradicated in 28 (93%) patients. Complications occurred in 9 patients and consisted of pin-site infection managed by lavage (n=3), recurrent infection requiring revision surgery for debridement and lavage combined with material exchange and antibiotic therapy (n=2), and femoral shaft fracture (n=3) or traumatic fracture of the arthrodesis (n=1) treated by changing the clamp and fixator assembly. DISCUSSION The fusion rate achieved using this combined technique is high and better than obtained with external fixation alone. Our results confirm that infection eradication is obtained more often than with nailing. This one-stage, simple, reproducible procedure does not leave any foreign material in situ. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Rayane Benhenneda
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France.
| | - Louis-Romée Le Nail
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Jérôme Druon
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Maxime Saad
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Philippe Rosset
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Ramy Samargandi
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Alvarez-Roman T, Gomez-Cardero P, Encinas-Ullan CA, Jimenez-Yuste V. Total knee arthroplasty in hemophilia: lessons learned and projections of what's next for hemophilic knee joint health. Expert Rev Hematol 2022; 15:65-82. [PMID: 35041571 DOI: 10.1080/17474086.2022.2030218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The purpose of this article has been to review the literature on total knee arthroplasty (TKA) in people with hemophilia (PWH), to mention the lessons we have learned from our own experience and to try to find out what the future of this type of surgery will be. AREAS COVERED A Cochrane Library and PubMed (MEDLINE) search of studies related to TKA PWH was analyzed. In PWH, the complication rate after TKA can be up to 31.5%. These include infection (7.1%) and bleeding in the form of hematoma, hemarthrosis or popliteal artery injury (8.9%). In a meta-analysis the revision arthroplasty rate was 6.3%. One-stage or two-stage revision arthroplasty due to infection (septic loosening) is not always successful despite providing correct treatment (both hematological and surgical). In fact, the risk of prosthetic re-infection is about 10%. It is necessary to perform a re-revision arthroplasty, which is a high-risk and technically difficult surgery that can sometimes end in knee arthrodesis or above-the-knee amputation of the limb. EXPERT OPINION TKA (both primary and revision) should be performed in centers specialized in orthopedic surgery and rehabilitation (knee) and hematology (hemophilia), and with optimal coordination between the medical team.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Bauer T, Senneville E, Gehrke T. Is there still room for improvement in the diagnosis, treatment and prevention of bone and joint infection? Orthop Traumatol Surg Res 2021; 107:102928. [PMID: 33857682 DOI: 10.1016/j.otsr.2021.102928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, université Paris-Saclay, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Eric Senneville
- ULR 4490, département universitaire de chirurgie orthopédique et traumatologique, CHU de Lille, University Lille, 59000 Lille, France
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767 Hamburg, Germany
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Suda AJ, Brachtendorf X, Tinelli M, Wagokh R, Abou-Nouar G, Bischel OE. Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator-a series of one hundred fifty two patients. INTERNATIONAL ORTHOPAEDICS 2021; 45:1735-1744. [PMID: 33893523 DOI: 10.1007/s00264-021-05054-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE Arthrodesis of the knee joint is still a salvage procedure after recurrent prosthetic joint infections (PJI) of total knee arthroplasties (TKA) with substantial bone loss and seems to be a good solution to avoid amputation. Until now, intramedullary arthrodesis has increasingly been performed; no study has yet been published to compare these techniques after septic removal of TKA in terms of functional assessment and quality of daily life. METHODS In a single-centre retrospective setting, clinical and radiographic evaluation of consecutive patients after knee arthrodesis using intramedullary and external fixation for infected knee joints was performed. All patients were evaluated clinically, with x-ray and questionnaire including analysis regarding any complications at latest follow-up of a minimum 12 months postoperatively. RESULTS We included 152 patients (75 females, 77 males) in this study. The mean age of the patients at surgery was 63.6 years (range 12 to 90 years). The minimum follow-up was 12 months (mean 3.1 years, range 12 to 49 months). Arthrodesis with external fixator (83 patients, 52.2%) showed less blood loss and less peri-operative complications (1.6%) but a high rate of post-operative, pin-track infections (35.5%); loose pins (12.7%); and pin fractures (4.8%), and therefore risk factors for instability and nonunion (30.9%). Revision rate was 22.6% for arthrodesis with external fixator, and the primary union rate was 65.6%. Intramedullary arthrodesis (69 patients, 43.4%) showed a similar re-infection rate to external fixation (16.1% and 15.9%, respectively) but a significantly lower revision rate (5.4%, p < 0.001). Eighty percent of patients with intramedullary arthrodesis showed very good patient-related outcomes regarding pain, function and daily life activities in the questionnaire. CONCLUSION Despite similar results regarding patient satisfaction and everyday competences in questionnaires, intramedullary arthrodesis of the knee is superior to the external fixator, as it results in fewer complications, lower revision rate, and union rates/loosening.
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Affiliation(s)
- Arnold J Suda
- AUVA Trauma Center Salzburg, Department of Orthopaedics and Trauma Surgery, Academic Teaching Hospital of Paracelsus Medical University, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria.
| | - Xaver Brachtendorf
- BG Trauma Center Ludwigshafen, Department of Trauma and Orthopaedics, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Marco Tinelli
- Sinsheim Hospital, Department of Orthopaedics and Trauma Surgery, Sinsheim, Germany
| | - Raed Wagokh
- Jordanian Royal Medical Services, Department of Orthopaedics, Amman, Jordan
| | - Ghaith Abou-Nouar
- Jordanian Royal Medical Services, Department of Orthopaedics, Amman, Jordan
| | - Oliver E Bischel
- BG Trauma Center Ludwigshafen, Department of Trauma and Orthopaedics, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
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