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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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Li S, Meng Y, Pan J, Sun Y. Novel, static, permanent spacers to treat chronic knee periprosthetic joint infections. INTERNATIONAL ORTHOPAEDICS 2023; 47:2585-2589. [PMID: 37421425 PMCID: PMC10522755 DOI: 10.1007/s00264-023-05884-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To discuss a static and permanent spacer in the treatment of chronic periprosthetic knee infection. Methods In this study, patients who were diagonised with chronic periprosthetic knee infection and not appropriate to undergo revision operations were included and were treated with static and permanent spacers. Infection recurrence rate was recorded, Visual Analogue Scale (VAS) score and Knee Society Score (KSS) were used to record patients' pain and knee function before the operation and at the final follow-up (minimum 24 months). RESULTS Fifteen patients were identified for this study. Pain and function were significantly improved at the latest follow-up evaluation. One patient had a recurrent infection and underwent amputation. No patients had signs of residual instability at the final follow-up evaluation, and no breakage or subsidence of the antibiotic spacer were identified at the final radiographic follow-up evaluation. CONCLUSION Our study provided evidence that the static and permanent spacer was a reliable salvage procedure to treat periprosthetic knee infection in compromised patients.
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Affiliation(s)
- Shuailei Li
- Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, Henan, China
| | - Yanyan Meng
- Department of Neurology, Zhengzhou Central Hospital, Zhengzhou, 450000, Henan, China
| | - Jiankang Pan
- Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, Henan, China.
| | - Yongqiang Sun
- Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, 450000, Henan, China.
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Knee Arthrodesis: An Analysis of Surgical Risk Factors and Complications Using a National Database. Arthroplast Today 2023; 20:101098. [PMID: 36793586 PMCID: PMC9922781 DOI: 10.1016/j.artd.2023.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/06/2022] [Accepted: 01/02/2023] [Indexed: 01/29/2023] Open
Abstract
Background Knee arthrodesis is predominantly a salvage procedure. In present time, knee arthrodesis is mostly considered for cases of unreconstructable failed total knee arthroplasty after prosthetic joint infection or trauma. Knee arthrodesis has shown better functional outcomes than amputation for these patients but has a high complication rate. The purpose of this study was to characterize the acute surgical risk profile of patients undergoing a knee arthrodesis for any indication. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried to determine 30-day outcomes after knee arthrodesis between 2005 and 2020. Demographics, clinical risk factors, and postoperative events were analyzed, along with reoperation and readmission rates. Results A total of 203 patients that underwent a knee arthrodesis were identified. Forty-eight percent of patients had at least 1 complication. The most common complication was acute surgical blood loss anemia requiring a blood transfusion (38.4%), followed by organ space surgical site infection (4.9%), superficial surgical site infection (2.5%), and deep vein thrombosis (2.5%). Smoking was associated with higher rates of reoperation and readmission (odds ratio 9, P < .01, and odds ratio 6, P < .05). Conclusions Overall, knee arthrodesis is a salvage procedure that has a high rate of early postoperative complications and is most often performed in patients at higher risk. Early reoperation is strongly associated with a poor preoperative functional status. Smoking places patients at higher risk of early complications.
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Luyet A, Steinmetz S, Gallusser N, Roche D, Fischbacher A, Tissot C, Borens O. Fusion rate of 89% after knee arthrodesis using an intramedullary nail: a mono-centric retrospective review of 48 cases. Knee Surg Sports Traumatol Arthrosc 2021; 31:1299-1306. [PMID: 34458941 PMCID: PMC10050040 DOI: 10.1007/s00167-021-06693-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/07/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate. METHODS A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2™ Arthrodesis Nail, 6 OsteoBridge® Knee Arthrodesis and 27 Wichita® fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6-18 years). RESULTS Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita® fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%). CONCLUSION Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita® fusion nail shows a tendency to better results compared to the two other nails. LEVEL OF EVIDENCE Case series, level IV.
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Affiliation(s)
- Anaïs Luyet
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Nicolas Gallusser
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - David Roche
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Arnaud Fischbacher
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christophe Tissot
- Clinique de la Source, Avenue Bergières 2, 1004, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedics and Traumatology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Knee Joint Bone Defects: Reconstruction With Bone Transport and Arthrodesis. J Arthroplasty 2021; 36:2896-2906. [PMID: 33812709 DOI: 10.1016/j.arth.2021.03.009] [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: 02/01/2021] [Revised: 02/20/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The increasing in primary total knee arthroplasty has led to an increase in infectious complications, revision surgery, and bone loss. Knee joint bone defects (KJBD) may be managed using bone transport and arthrodesis with Ilizarov or bone transport over nail (BTON) techniques. The aim of this study is to compare both techniques in the reconstruction of KJBDs. METHODS This was a retrospective cohort study of 29 patients with extensive KJBD. All patients underwent reconstruction of the KJBD using bone transport (either Ilizarov or BTON techniques). The primary outcome variables for comparison between the two groups included time in frame (days), external fixation index (EFI, days/cm), residual limb length discrepancy (cm), and complications (Caton classification). RESULTS Gender and age profiles were comparable. Mean time spent in frame for bone transport was 566 days (σ = 236, 95% CI 429-702) for the Ilizarov cohort and 191 days (σ = 162, 95% CI 101-280) for BTON (P < .0001). EFI for the period of bone transport was 75.1 d/cm (σ = 41.5, 95% CI 51.1- 99.1) for the Ilizarov cohort and 24.7 d/cm (σ = 24.0, 95% CI 11.4-38) for BTON (P = .0004). Union, limb length discrepancy and complication rates were comparable between both groups. CONCLUSION For the management of KJBD after failed total knee arthroplasty, BTON is preferred due to significantly less time spent in frame, lower EFI, and higher rates of normal mechanical alignment. The Ilizarov method may be useful when there is a contraindication to BTON.
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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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Sun J, Li Q, Gao F, Xiang Z, Huang Q, Li L. Application of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage tuberculosis of the knee. BMC Musculoskelet Disord 2020; 21:579. [PMID: 32847561 PMCID: PMC7447600 DOI: 10.1186/s12891-020-03603-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background With the global determination to eliminate tuberculosis (TB), the treatment for end-stage TB of the knee joint is still a great clinical challenge. This study aims to retrospectively determine the clinical and radiographic outcomes after use of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage knee TB. Methods Twenty-six patients with end-stage knee TB treated by external fixation with the Ilizarov fixator between 2012 and 2017 were examined. Anti-TB drugs were administered preoperatively, intraoperatively, and postoperatively. Clinical and radiologic examinations were performed for comprehensive evaluations, and these include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), flexion and valgus angle of the knee, leg-length discrepancy, and Lysholm score. Results Twenty-four patients were followed up for an average of 5.8 years (2.2–7 years). All patients achieved bone fusion within a mean of 6.4 months (4–16 months). The ESR and CRP concentrations were observed to return to normal within 5.1 ± 1.1 months postoperatively. There was no recurrence of TB. At last follow-up, the mean leg-length discrepancy was 2.7 ± 1.4 cm, and the mean alignment was 8.7 ± 2.6° flexion and 5.3 ± 1.0° valgus. No patient had a significant rotational deformity. The average Lysholm score was seen to improve significantly from 36.8 ± 18.4 preoperatively to 79.5 ± 5.9 at final follow-up (p < 0.0001). Conclusion This study has demonstrated that the Ilizarov technique for knee joint arthrodesis as a treatment of end-stage knee TB achieved promising outcomes with minimal complications.
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Affiliation(s)
- Jiachen Sun
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Qiang Li
- Department of Orthopaedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, NO.20 Ximianqiao Cross Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Feng Gao
- Department of Orthopaedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, NO.20 Ximianqiao Cross Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Qi Huang
- Department of Orthopaedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, NO.20 Ximianqiao Cross Street, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Lang Li
- Department of Orthopaedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, NO.20 Ximianqiao Cross Street, Chengdu, 610041, Sichuan, People's Republic of China.
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Chalmers BP, Matrka AK, Sems SA, Abdel MP, Sierra RJ, Hanssen AD, Pagnano MW, Mabry TM, Perry KI. Two-stage arthrodesis for complex, failed, infected total knee arthroplasty. Bone Joint J 2020; 102-B:170-175. [PMID: 32475264 DOI: 10.1302/0301-620x.102b6.bjj-2019-1554.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients. METHODS We retrospectively identified 41 patients (41 TKAs) with a complex infected TKA, who were treated between 2002 and 2016 using a deliberate, two-stage knee arthrodesis. Their mean age was 64 years (34 to 88) and their mean body mass index (BMI) was 39 kg/m2 (25 to 79). The mean follow-up was four years (2 to 9). The extensor mechanism (EM) was deficient in 27 patients (66%) and flap cover was required in 14 (34%). Most patients were host grade B (56%) or C (29%), and limb grade 3 (71%), according to the classification of McPherson et al. A total of 12 patients (29%) had polymicrobial infections and 20 (49%) had multi-drug resistant organisms; fixation involved an intramedullary nail in 25 (61%), an external fixator in ten (24%), and dual plates in six (15%). RESULTS Survivorship free from amputation, persistent infection, and reoperation, other than removal of an external fixator, at five years was 95% (95% confidence interval (CI) 89% to 100%), 85% (95% CI 75% to 95%), and 64% (95% CI 46% to 82%), respectively. Reoperation, other than removal of an external fixator, occurred in 13 patients (32%). After the initial treatment, radiological nonunion developed in ten knees (24%). Nonunion was significantly correlated with persistent infection (p = 0.006) and external fixation (p = 0.005). Of those patients who achieved limb salvage, 34 (87%) remained mobile and 31 (79%) had 'absent' or 'minimal' pain ratings. CONCLUSION Knee arthrodesis using a two-stage protocol achieved a survivorship free from amputation for persistent infection of 95% at five years with 87% of patients were mobile at final follow-up. However, early reoperation was common (32%). This is not surprising as this series included worst-case infected TKAs in which two-thirds of the patients had a disrupted EM, one-third required flap cover, and most had polymicrobial or multi-drug resistant organisms. Cite this article: Bone Joint J 2020;102-B(6 Supple A):170-175.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexis K Matrka
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen A Sems
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin I Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Makhdom AM, Buksbaum J, Rozbruch SR, Da Cunha R, Fragomen AT. Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up. J Bone Jt Infect 2020; 5:176-183. [PMID: 32670771 PMCID: PMC7358971 DOI: 10.7150/jbji.46570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background: To report on our experience with antibiotic cement coated interlocking intramedullary nails (ACC-IMNs) for limb salvage in septic complex lower extremity reconstruction with a minimum of 2-year follow up. Methods: We retrospectively reviewed the records of all consecutive patients who underwent a limb salvage procedure with ACC-IMNs. We reviewed patients' demographics, the preoperative infecting organism, and host type, time to bone union, complications, limb salvage rates, and infection control rates. Results: There were 28 patients with a mean age of 62 years (range 22-88). The mean follow up period was 40 months (range 28-84). The ACC-IMNs were used in 14 patients (50 %) to achieve knee fusion after failed revisions of infected total knee arthroplasty, in 8 patients (28%) for septic tibial nonunion, and in 6 patients (21%) with ankle fusion nonunions. Bony union/fusion was achieved in 87 % (21/24) of patients. The infection was controlled in 80% (21/26) of patients. Four out the five patients who had recurrent infection were type B hosts (p=0.63). The limb salvage rate was 89% (25/28). The overall complication rate was 32%. Conclusions: The use of ACC-IMNs was an effective treatment strategy and associated with high limb salvage and bone union rates. Furthermore, the infection recurrence rate was low. Knee fusion patients after failed TKA should be counseled preoperatively for a potential high complication rate.
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Affiliation(s)
- Asim M Makhdom
- Foothills Medical Group, Upper Alleghany Health System, Olean, NY and Bradford, PA, USA
| | - Joshua Buksbaum
- Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA.,SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, NY, USA
| | - S Robert Rozbruch
- Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Rachael Da Cunha
- Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Austin T Fragomen
- Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA
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Ransone M, Fehring K, Curtin B, Mason JB. Peri-implant fracture after dual-plating knee arthrodesis for failed total knee arthroplasty: case series. Arthroplast Today 2019; 5:453-464. [PMID: 31886389 PMCID: PMC6921173 DOI: 10.1016/j.artd.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 11/12/2022] Open
Abstract
Knee arthrodesis is an option in the setting of failed total knee arthroplasty. Dual-plate fixation is a described technique to obtain knee fusion in this scenario. Literature on the complications of knee arthrodesis with dual-plate constructs is limited. We present 3 cases who underwent dual-plate knee arthrodesis complicated by peri-implant femur fracture.
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Affiliation(s)
- Michael Ransone
- Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - Brian Curtin
- OrthoCarolina Hip & Knee Center, Charlotte, NC, USA
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11
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Hönle W, Ndubuisi O, Scheller A, Jezussek D, Schuh A. [Painful total knee arthroplasty - operative and conservative therapy]. MMW Fortschr Med 2019; 161:56-64. [PMID: 31414471 DOI: 10.1007/s15006-019-0023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wolfgang Hönle
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland.
| | - Onyemaechi Ndubuisi
- Department of Surgery, University of Nigeria Teaching Hospital Ituku-Ozalla Enugu, Enugu, Nigeria
| | - Alexander Scheller
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
| | - Damian Jezussek
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
| | - Alexander Schuh
- Muskuloskelettales Zentrum Klinikum Neumarkt, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberger Str. 12, D-92318, Neumarkt i. d. OPf., Deutschland
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Middleton R, Khan T, Alvand A. Update on the diagnosis and management of prosthetic joint infection in hip and knee arthroplasty. ACTA ACUST UNITED AC 2019. [DOI: 10.1302/2048-0105.84.360701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- R. Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - T. Khan
- Department of Academic Orthopaedics & Trauma Surgery, Queen’s Medical Centre, Nottingham, UK
| | - A. Alvand
- Nuffield Orthopaedic Centre, Oxford, UK; University of Oxford, Oxford UK
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