Salvage of infected total knee arthroplasty with Ilizarov external fixator

Abstract

Background:Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA) with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA.Materials and Methods:16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator.Results:Union was achieved in 15 patients (93.75%). The mean duration for union (frame application time) in these patients was 28.33 weeks (range 22 to 36 weeks). Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034). Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls) was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035).Conclusion:Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.

“…However, there was a tendency toward better results using circular fixators and wires. Despite numerous disadvantages (frame maintenance, cosmetic discomfort, risk of neurovascular damage during wire insertion), circular external fixation offers possible progressive adjustment to stimulate the bony fusion while keeping maximum triplanar stability at the arthrodesis site [ 32 ]. The severe bone defect represents a specific problem following multiple revisions for PJI and direct bony union in these circumstances will result in marked LLD.…”

Arthrodesis of the Infected Knee Joint with the Ilizarov External Fixator: an Analysis of 13 Cases

“…On the other hand, an Ilizarov external fixator, as a circular fixator with wires and bone screws, achieves dynamic axial fixation with high stability against bending, shear, and torsion forces [17]. Therefore, the advantages of this fixator lie in the strain-stable osteosynthesis capability outside the immediate area of infection in chronic osteomyelitis of the femur and tibia and severe soft-tissue conditions [8,15,16,19]. A direct full-load capacity of the affected extremity is indeed difficult due to the protruding fixator but is, in principle, possible.…”

Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

“… 15 25 26 It is known that the Ilizarov apparatus provides bone stability in the settling of osteomyelitis and there are reports that describe the use of external fixators for solid fusions of large joints with recurrent osteomyelitis. 27 Recent reports also show that these methods have remained therapeutic alternatives when patient perceived effect on the quality of life is concerned by patients. 28 Both solutions were considered as salvage procedures in the management of severe infection around the implant.…”