Arthrodesis of the knee after failed infected total knee arthroplasty

Abstract

Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.

Better Function for Fusions Versus Above-the-knee Amputations for Recurrent Periprosthetic Knee Infection

“…SF-12 measurements in our patients with fusion are comparable to other patients with fusion in the literature [6,34]. Of note, the finding that the MCS scores were lower in patients undergoing AKA compared to patients undergoing fusion is different from the findings in the tumor literature [1,12].…”

“…When chronic antibiotic suppression and reimplantation do not work, knee arthrodesis, AKA, and resection are the only remaining options. Klinger et al [34] reported a series of 20 patients who underwent arthrodesis as a treatment for failed infected TKA and found arthrodesis provided a stable and painless extremity for ambulation after failed infected TKA. On the other hand, older trauma studies demonstrated patients receiving fusions do worse than those receiving amputations, as they have worse limb function, decreased quality of life, and more complications [16,18].…”

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

“…Pain was assessed in all patients with a VAS, which uses a simple numerical score of 0 to 10 [18]. The assessment of health-related quality of life after the procedure was measured used the SF-12 Health Survey version 2 (SF12v2) [31].…”

The Soft Tissue Repair and Knee Arthrodesis with Ilizarov Method in the Treatment of the Open Wound Which is Secondary to the Total Knee Prosthesis: Case Report

“…[1][2][3][4][5][6][7] Ek lem don du rul ma sı, in ternal ve eks ter nal fik sas yon yön tem le ri ile uy gu la nabil mek te dir. İli za rov eks ter nal fik sa tör tek ni ği nin kul la nıl dı ğı ek lem don du rul ma sı uy gu la ma sı nın bir çok avan ta jı bu lun mak ta dır.…”

“…Plak vi da tes pi ti nin ise ya ra ka pa ma da ki zor luk lar, plak kı rıl ma sı, en fek te vaka lar da uy gu la na ma ma sı gi bi so run la rı mev cuttur. 3,7 Eks ter nal fik sas yon yön tem le ri ara sın da tek ve ya iki düz lem li fik sa tör ler, İli za rov fik sa tö rü sayı la bi lir. İli za rov eks ter nal fik sa tör kul la nı la rak yapı lan ek lem don du rul ma sı nın bir çok avan ta jı var dır.…”