Abstract
Background and Objective: Persistent periprosthetic joint infection (PJI) is a devastating complication after Total Knee Arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss. Methods: In a retrospective case series, 15 consecutive patients who underwent knee arthrodesis after failed ipsilateral TKA secondary to infection from 2004-2017 with at least 1 year of follow-up were enrolled. The average age of patients at the time surgery was 68 (range 50-81) years with an average follow-up of 3.2 (range 1-6) years. Post-surgical ambulation status and eradication of index infection were analyzed as primary outcomes using McNemar’s test for before-and-after study design with p<0.05 for significance. Results: Cement arthrodesis significantly improved ambulation with 67% (10/15) of patients unable to ambulate before arthrodesis and 93% (14/15) of patients able to ambulate at final follow-up (p=0.004). The complication rate was 20% (3/15). There were no periprosthetic fractures. Amongst patients who presented with active PJI, 91% (10/11) had eradication of their index infection final follow-up (p=0.002). Overall prevention of recurrent index infection was 93% (14/15) (p=0.0001). Conclusion: Cement arthrodesis utilizing a custom knee spanning recon nail combined with an antibiotic eluting spacer improves ambulation status and prevents or treats recurrent infection in the majority of patients who have failed total knee arthroplasty.
Highlights
Knee arthrodesis should be strongly considered as a limb-sparing procedure in the setting of failed Total Knee Arthroplasty (TKA) with severe bone and/or soft tissue loss [1 - 17]
The Open Orthopaedics Journal, 2018, Volume 12 555 mechanism dysfunction, soft tissue compromise, and severe bone loss, with almost half of patients having more than one indication [1]
Knee arthrodesis has been performed for over 2000 years, with evidence of a clinically healed knee fusion demonstrated from radiographic studies of an Egyptian mummy dating from the classical era (Appendix 1)
Summary
Knee arthrodesis should be strongly considered as a limb-sparing procedure in the setting of failed Total Knee Arthroplasty (TKA) with severe bone and/or soft tissue loss [1 - 17]. The most common indication for knee arthrodesis after TKA is a persistent Periprosthetic Joint Infection (PJI) after staged revision procedures proved unsuccessful [1, 21]. [22] Revision TKA in the setting of infection confers a 7% lifetime risk of arthrodesis or amputation [23]. Persistent periprosthetic joint infection (PJI) is a devastating complication after Total Knee Arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss
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