Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency

• Published in: The knee Vol. 24; no. 5; pp. 1240 - 1246
• Main Authors: Friedrich, Max J, Schmolders, Jan, Wimmer, Matthias D, Strauss, Andreas C, Ploeger, Milena M, Wirtz, Dieter C, Gravius, Sascha, Randau, Thomas M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-10-2017; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Anti-Bacterial Agents - administration & dosage; Antibiotics; Arthrodesis; Arthrodesis - instrumentation; Arthrodesis - methods; Arthroplasty (knee); Arthroplasty, Replacement, Knee - adverse effects; Bone loss; Debridement; Device Removal; Eradication; Fracture Fixation, Intramedullary - methods; Humans; Infection; Infections; Joint diseases; Joint surgery; Knee; Knee Prosthesis; Leg; Middle Aged; Orthopedics; Outcome; Pain; Pathogens; Patients; Prostheses; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Prosthetic joint infection; Recurrent infection; Reoperation - adverse effects; Reoperation - instrumentation; Reoperation - methods; Revision; Risk factors; Soft Tissue Infections - etiology; Soft Tissue Infections - surgery; Surgeons; Surgery; Survival; Therapeutic Irrigation; Transplants & implants; Two-stage procedure; Visual perception; Infection; Arthrodesis; Two-stage procedure; Revision; Prosthetic joint infection; Outcome
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2017.05.019

Abstract Background Periprosthetic joint infection is a serious complication and reconstruction after failed revision total knee arthroplasty with significant bone loss and compromised soft-tissues can be challenging. Objective of this study was to assess clinical and functional results, implant survival and infection recurrence rates in patients treated with two-stage arthrodesis after failed revision TKA with extensor mechanism deficiencies due to PJI, and to identify the factors that affect outcomes after surgery. Methods Thirty seven patients with PJI treated within a two-stage exchange and reimplantation of an arthrodesis nail between 2008 and 2014 were included. Systemic and local risk factors were graded preoperatively according to McPherson et al. All patients were treated according to a structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford Knee Score and the Visual Analogue Scale. Results Thirty two of 37 patients (86.5%) were graded as free of infection. Five patients (13.5%) had recurrent infection after arthrodesis with the need of revision surgery. Mean leg-length discrepancy was 2.2 cm. The mean VAS for pain was three, the mean Oxford Knee Score was 38 ± 9. Total implant survival at a 74 month follow-up was 74.3% (95% CI: 45.4 to 91.1%), as determined by Kaplan–Meier survival curves. Local McPherson Score, as well as number of revisions was found to be of significant influence to the survival rate. Conclusions Septic failure of revision knee arthroplasty can be effectively treated with two-stage arthrodesis using a modular intramedullary nail, providing a stable and painless limb with satisfactory functional results and acceptable infection eradication rates.