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.
Complications
External fixator
Intramedullary nail
Knee arthrodesis
Quality of life
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
23
01
2021
accepted:
19
04
2021
pubmed:
25
4
2021
medline:
23
7
2021
entrez:
24
4
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 33893523
doi: 10.1007/s00264-021-05054-w
pii: 10.1007/s00264-021-05054-w
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1735-1744Références
Rajaee SS, Kavolus JJ, Hayden BL, Estok DM (2021) National decline in knee fusions performed for salvage of chronic periprosthetic total knee infections. J Knee Surg. https://doi.org/10.1055/s-0040-1721126
Mayes WH, Severin AC, Mannen EM, Edwards PK, Barnes CL, Stambough JB, Mears SC (2021) Management of periprosthetic joint infection and extensor mechanism disruption with modular knee fusion: clinical and biomechanical outcomes. Arthroplast Today 8:46–52. https://doi.org/10.1016/j.artd.2020.12.008
doi: 10.1016/j.artd.2020.12.008
pubmed: 33718555
pmcid: 7921710
Yeung CM, Lichstein PM, Varady NH, Maguire JH, Chen AF, Estok DM 2nd (2020) Knee arthrodesis is a durable option for the salvage of infected total knee arthroplasty. J Arthroplast 35:3261–3268. https://doi.org/10.1016/j.arth.2020.06.034
doi: 10.1016/j.arth.2020.06.034
Makhdom AM, Fragomen A, Rozbruch SR (2019) Knee arthrodesis after failed total knee arthroplasty. J Bone Joint Surg Am 101:650–660. https://doi.org/10.2106/jbjs.18.00191
doi: 10.2106/jbjs.18.00191
pubmed: 30946199
Gottfriedsen TB, Schrøder HM, Odgaard A (2016) Knee arthrodesis after failure of knee arthroplasty: a nationwide register-based study. J Bone Joint Surg Am 98:1370–1377. https://doi.org/10.2106/jbjs.15.01363
doi: 10.2106/jbjs.15.01363
pubmed: 27535439
Wood JH, Conway JD (2015) Advanced concepts in knee arthrodesis. World J Orthop 6:202–210. https://doi.org/10.5312/wjo.v6.i2.202
doi: 10.5312/wjo.v6.i2.202
pubmed: 25793160
pmcid: 4363802
Conway JD (2020) Knee arthrodesis for recurrent periprosthetic knee infection. JBJS Essent Surg Tech 10. https://doi.org/10.2106/jbjs.St.19.00027
Chalmers BP, Matrka AK, Sems SA, Abdel MP, Sierra RJ, Hanssen AD, Pagnano MW, Mabry TM, Perry KI (2020) Two-stage arthrodesis for complex, failed, infected total knee arthroplasty. Bone Joint J 102-b:170–175. https://doi.org/10.1302/0301-620x.102b6.Bjj-2019-1554.R1
doi: 10.1302/0301-620x.102b6.Bjj-2019-1554.R1
pubmed: 32475264
Balci HI, Saglam Y, Pehlivanoglu T, Sen C, Eralp L, Kocaoglu M (2016) Knee arthrodesis in persistently infected total knee arthroplasty. J Knee Surg 29:580–588. https://doi.org/10.1055/s-0035-1569479
doi: 10.1055/s-0035-1569479
pubmed: 26683977
Bargiotas K, Wohlrab D, Sewecke JJ, Lavinge G, DeMeo PJ, Sotereanos NG (2007) Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. Surgical technique. J Bone Joint Surg Am 89 Suppl 2 Pt.1:103–110. https://doi.org/10.2106/jbjs.F.01125
Bengtson S, Knutson K (1991) The infected knee arthroplasty: a 6-year follow-up of 357 cases. Acta Orthop Scand 62:301–311
doi: 10.3109/17453679108994458
Vlasak R, Gearen PF, Petty W (1995) Knee arthrodesis in the treatment of failed total knee replacement. Clin Orthop Relat Res:138–144
Böhle S, Rohe S, Kirschberg J, Brinkmann O, Seeger J, Zippelius T, Matziolis G, Röhner E (2020) Poor outcome of above-knee amputation after septic failure of revision total knee arthroplasty. J Knee Surg. https://doi.org/10.1055/s-0040-1716416
Carr JB 2nd, Werner BC, Browne JA (2016) Trends and outcomes in the treatment of failed septic total knee arthroplasty: comparing arthrodesis and above-knee amputation. J Arthroplast 31:1574–1577. https://doi.org/10.1016/j.arth.2016.01.010
doi: 10.1016/j.arth.2016.01.010
Hungerer S, Kiechle M, von Rüden C, Militz M, Beitzel K, Morgenstern M (2017) Knee arthrodesis versus above-the-knee amputation after septic failure of revision total knee arthroplasty: comparison of functional outcome and complication rates. BMC Musculoskelet Disord 18:443. https://doi.org/10.1186/s12891-017-1806-8
doi: 10.1186/s12891-017-1806-8
pubmed: 29132347
pmcid: 5683527
Zajonz D, Zimmerlich B, Möbius R, Edel M, Przybyl J, Höch A, Fakler JKM, Roth A, Ghanem M (2021) Knee arthrodesis as last resort for persistent knee joint infections : comparison of extramedullary and intramedullary treatment. Orthopade 50:207–213. https://doi.org/10.1007/s00132-020-03939-z
doi: 10.1007/s00132-020-03939-z
pubmed: 32666143
Faure PA, Putman S, Senneville E, Beltrand E, Behal H, Migaud H (2021) Knee arthrodesis using a custom modular intramedullary nail in failed, infected knee arthroplasties: a concise follow-up note of 31 cases at a median of 13 years post-arthrodesis. Orthop Traumatol Surg Res:102898. https://doi.org/10.1016/j.otsr.2021.102898
Reinke C, Bäcker H, Lotzien S, Schildhauer TA, Seybold D, Gessmann J (2020) Arthrodesis of the infected knee joint with the Ilizarov external fixator: an analysis of 13 cases. Z Orthop Unfall 158:58–74. https://doi.org/10.1055/a-0869-8190
doi: 10.1055/a-0869-8190
pubmed: 31533167
Corona PS, Jurado M, Scott-Tennent A, Fraile R, Carrera L, Vicente M (2020) Uniplanar versus biplanar monolateral external fixator knee arthrodesis after end-stage failed infected total knee arthroplasty: a comparative study. Eur J Orthop Surg Traumatol 30:815–825. https://doi.org/10.1007/s00590-020-02633-2
doi: 10.1007/s00590-020-02633-2
pubmed: 32020375
Aparicio G, Otero J, Bru S (2020) High rate of fusion but high complication rate after knee arthrodesis for infected revision total knee replacement. Indian J Orthop 54:616–623. https://doi.org/10.1007/s43465-020-00163-x
doi: 10.1007/s43465-020-00163-x
pubmed: 32850025
pmcid: 7429668
Alt V, Heiss C, Rupp M (2019) Treatment of a recurrent periprosthetic joint infection with an intramedullary knee arthrodesis system with low-amount metallic silver coating. J Bone Jt Infect 4:111–114. https://doi.org/10.7150/jbji.34484
doi: 10.7150/jbji.34484
pubmed: 31192109
pmcid: 6536804
White CJ, Palmer AJR, Rodriguez-Merchan EC (2018) External fixation vs intramedullary nailing for knee arthrodesis after failed infected total knee arthroplasty: a systematic review and meta-analysis. J Arthroplast 33:1288–1295. https://doi.org/10.1016/j.arth.2017.10.055
doi: 10.1016/j.arth.2017.10.055
Gathen M, Wimmer MD, Ploeger MM, Weinhold L, Schmid M, Wirtz DC, Gravius S, Friedrich MJ (2018) Comparison of two-stage revision arthroplasty and intramedullary arthrodesis in patients with failed infected knee arthroplasty. Arch Orthop Trauma Surg 138:1443–1452. https://doi.org/10.1007/s00402-018-3007-9
doi: 10.1007/s00402-018-3007-9
pubmed: 30054812
Hontzsch D (2010) External fixation osteosynthesis. Orthopade 39:192–200. https://doi.org/10.1007/s00132-009-1523-6
doi: 10.1007/s00132-009-1523-6
pubmed: 20127069
Garberina MJ, Fitch RD, Hoffmann ED, Hardaker WT, Vail TP, Scully SP (2001) Knee arthrodesis with circular external fixation. Clin Orthop Relat Res:168–178. https://doi.org/10.1097/00003086-200101000-00023
Crockarell JR Jr, Mihalko MJ (2005) Knee arthrodesis using an intramedullary nail. J Arthroplast 20:703–708. https://doi.org/10.1016/j.arth.2004.10.015
doi: 10.1016/j.arth.2004.10.015
Matar HE, Stritch P, Emms N (2018) Outcomes of implant-arthrodesis as limb salvage for failed total knee arthroplasties with significant bone loss: case series. J Long-Term Eff Med Implants 28:347–353. https://doi.org/10.1615/JLongTermEffMedImplants.2019030369
doi: 10.1615/JLongTermEffMedImplants.2019030369
pubmed: 31002626
Hawi N, Kendoff D, Citak M, Gehrke T, Haasper C (2015) Septic single-stage knee arthrodesis after failed total knee arthroplasty using a cemented coupled nail. Bone Joint J 97-b:649–653. https://doi.org/10.1302/0301-620x.97b5.34902
doi: 10.1302/0301-620x.97b5.34902
pubmed: 25922459
von Stein T, Gollwitzer H, Kruis C, Buhren V (2006) Arthrodesis after total knee arthroplasty considering septic loosening as an example. Orthopade 35:946, 948–952, 954–945. https://doi.org/10.1007/s00132-006-0980-4
Fern ED, Stewart HD, Newton G (1989) Curved Kuntscher nail arthrodesis after failure of knee replacement. J Bone Joint Surg Br 71:588–590
doi: 10.1302/0301-620X.71B4.2768302
Incavo SJ, Lilly JW, Bartlett CS, Churchill DL (2000) Arthrodesis of the knee-experience with intramedullary nailing. J Arthroplasty 15:871–876. https://doi.org/10.1054/arth.2000.9060
doi: 10.1054/arth.2000.9060
pubmed: 11061447
Puranen J, Kortelainen P, Jalovaara P (1990) Arthrodesis of the knee with intramedullary nail fixation. J Bone Joint Surg Am 72:433–442
doi: 10.2106/00004623-199072030-00018
Conway JD, Mont MA, Bezwada HP (2004) Arthrodesis of the knee. J Bone Joint Surg Am 86-A:835–848
doi: 10.2106/00004623-200404000-00027
Balato G, Rizzo M, Ascione T, Smeraglia F, Mariconda M (2018) Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis. BMC Musculoskelet Disord 19:361. https://doi.org/10.1186/s12891-018-2283-4
doi: 10.1186/s12891-018-2283-4
pubmed: 30301462
pmcid: 6178263
Röhner E, Windisch C, Nuetzmann K, Rau M, Arnhold M, Matziolis G (2015) Unsatisfactory outcome of arthrodesis performed after septic failure of revision total knee arthroplasty. J Bone Joint Surg Am 97:298–301. https://doi.org/10.2106/jbjs.N.00834
doi: 10.2106/jbjs.N.00834
pubmed: 25695981
pmcid: 4325086
Stuby FMWK (2006) Kniegelenksarthrodese. OP-Journal, Georg Thieme Verlag 22:190–193
Putman S, Kern G, Senneville E, Beltrand E, Migaud H (2013) Knee arthrodesis using a customised modular intramedullary nail in failed infected total knee arthroplasty. Orthop Traumatol Surg Res 99:391–398. https://doi.org/10.1016/j.otsr.2012.10.016
doi: 10.1016/j.otsr.2012.10.016
pubmed: 23510631
Sambri A, Bianchi G, Parry M, Frenos F, Campanacci D, Donati D, Jeys L (2019) Is arthrodesis a reliable salvage option following two-stage revision for suspected infection in proximal tibial replacements? A multi-institutional study. J Knee Surg 32:911–918. https://doi.org/10.1055/s-0038-1672121
doi: 10.1055/s-0038-1672121
pubmed: 30227450
Harris IE, Leff AR, Gitelis S, Simon MA (1990) Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am 72:1477–1485
doi: 10.2106/00004623-199072100-00008
Reddy VG, Kumar RV, Mootha AK, Thayi C, Kantesaria P, Reddy D (2011) Salvage of infected total knee arthroplasty with Ilizarov external fixator. Indian J Orthop 45:541–547. https://doi.org/10.4103/0019-5413.87127
doi: 10.4103/0019-5413.87127
pubmed: 22144748
pmcid: 3227359
Damron TA, McBeath AA (1995) Arthrodesis following failed total knee arthroplasty: comprehensive review and meta-analysis of recent literature. Orthopedics 18:361–368
doi: 10.3928/0147-7447-19950401-10
Oostenbroek HJ, van Roermund PM (2001) Arthrodesis of the knee after an infected arthroplasty using the Ilizarov method. J Bone Joint Surg Br 83:50–54
doi: 10.1302/0301-620X.83B1.0830050
Leroux B, Aparicio G, Fontanin N, Ohl X, Madi K, Dehoux E, Diallo S (2013) Arthrodesis in septic knees using a long intramedullary nail: 17 consecutive cases. Orthop Traumatol Surg Res 99:399–404. https://doi.org/10.1016/j.otsr.2013.03.011
doi: 10.1016/j.otsr.2013.03.011
pubmed: 23623438
Iacono F, Bruni D, Lo Presti M, Raspugli G, Bondi A, Sharma B, Marcacci M (2012) Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA. Knee 19:555–559. https://doi.org/10.1016/j.knee.2012.01.005
doi: 10.1016/j.knee.2012.01.005
pubmed: 22341529
Knutson K, Hovelius L, Lindstrand A, Lidgren L (1984) Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases. Clin Orthop Relat Res:202–211
Razii N, Abbas AM, Kakar R, Agarwal S, Morgan-Jones R (2016) Knee arthrodesis with a long intramedullary nail as limb salvage for complex periprosthetic infections. Eur J Orthop Surg Traumatol 26:907–914. https://doi.org/10.1007/s00590-016-1827-2
doi: 10.1007/s00590-016-1827-2
pubmed: 27473317
Arroyo JS, Garvin KL, Neff JR (1997) Arthrodesis of the knee with a modular titanium intramedullary nail. J Bone Joint Surg Am 79:26–35
doi: 10.2106/00004623-199701000-00003
Letartre R, Combes A, Autissier G, Bonnevialle N, Gougeon F (2009) Knee arthodesis using a modular customized intramedullary nail. Orthop Traumatol Surg Res 95:520–528. https://doi.org/10.1016/j.otsr.2009.07.006
doi: 10.1016/j.otsr.2009.07.006
pubmed: 19875349
Mabry TM, Jacofsky DJ, Haidukewych GJ, Hanssen AD (2007) Comparison of intramedullary nailing and external fixation knee arthrodesis for the infected knee replacement. Clin Orthop Relat Res 464:11–15. https://doi.org/10.1097/BLO.0b013e31806a9191
doi: 10.1097/BLO.0b013e31806a9191
pubmed: 17471102