Knee Arthrodesis Research Articles

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

BackgroundKnee arthrodesis with intramedullary (IM) nail or external fixator (EF) is the most reliable therapeutic option to achieve definitive infection control in patients with septic failure of total knee arthroplasty (TKA). The first aim of this study was to compare re-infection rates following knee arthrodesis for periprosthetic joint infection (PJI) with IM nail or EF. The second aim was to compare rates of radiographic union, complication, and re-operation as well as clinical outcomes.MethodsA systematic search was performed in electronic databases for longitudinal studies of PJIs (minimum ten patients; minimum follow-up = 1 year) treated by knee arthrodesis with IM nail or EF. Studies were also required to report the rate of re-infection as an outcome measure. Eligible studies were meta-analyzed using random-effect models.ResultsThe rate (95% confidence intervals) of re-infection was 10.6% (95% CI 7.3 to 14.0) in IM nail arthrodesis studies. The corresponding re-infection rate for EF was 5.4% (95% CI 1.7 to 9.1). This difference was significant (p = 0.009). The use of IM nail resulted in more advantages than EF for frequency of major complications and limb shortening. Other postoperative clinical and radiographic outcomes were similar for both surgical strategies.ConclusionsThe available evidence from the aggregate published data suggests that knee arthrodesis with EF in the specific context of PJI has a reduced risk of re-infection in comparison with the IM nail strategy. The use of IM nail is more effective for the complication rate and shortening of the affected limb.

HOW MANY REVISION ARTHROPLASTIES DO WE UNDERTAKE PRIOR TO ARTHRODESIS? (CASE REPORT OF A PATIENT WITH RHEUMATOID KNEE ARTHRITIS)

The authors present a clinical case of a female patient with seropositive rheumatoid polyarthritis mainly affecting the knee joints. The patient underwent a primary total bilateral knee replacement. Surgical site infection required multiple revisions including replacement of extensive bone defects of AORI type 3 by structural femur and tibia allografts as well as allografting of extensor mechanism. Repeated attempts to eliminate infection, to gain support ability of extremities and joints motion were not successful. Long-term staged surgical treatment resulted in removal of prostheses and bilateral knee arthrodesis to restore support function of the extremities.

What are the benefits and risks of total arthroplasty in arthrodesed knees?

The conversion of a previously arthrodesed knee to a total knee arthroplasty is an alternative seldom used. However, arthroplasty would provide greater functionality to the arthrodesed joint. Since it is a technically demanding procedure, not exempt from complications, there is controversy about the role of this intervention. To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We identified two systematic reviews including 10 studies overall, none of which corresponded to a randomized trial. We concluded the conversion of knee arthrodesis to total knee arthroplasty could increase the functionality, but it is not clear whether it increases the complications or if it has any impact on pain or patient satisfaction because the certainty of the evidence is very low.

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

The aim of this multicentric retrospective study was to verify whether knee arthrodesis (KA) is a viable reconstructive option after two-stage revision for infection of proximal tibia (PT) endoprosthetic reconstruction (EPR). Sixty patients who underwent a two-stage revision were included. Definitive EPR or a KA with a modular system was performed following consideration of soft tissue and extensor mechanism conditions. Patients were evaluated with Musculoskeletal Tumor Society Score and Oxford Knee Score. Implant survival was assessed on the basis of recurrence of infection. Five patients did not receive any reconstruction after the first stage. In 14 cases, a KA was performed, and in 41, an EPR was implanted. At 5 years follow-up, reinfection rate in the KA group was lower (10 vs. 17.5% in KA and EPR groups, respectively). In reinfected patients, the KA group had a reduced rate of amputation when compared with those with EPR (50 vs. 88%). Functional evaluation did not show any significant differences between the two groups. A successful KA using a modular implant can eradicate infection and allow preservation of the limb with good function and good pain relief in after two-stage revision for an infected PT EPR.

Оценка эффективности двухэтапного хирургического лечения больных с перипротезной инфекцией коленного и тазобедренного суставов

Introduction Two-stage revision arthroplasty is the gold standard of surgical treatment of periprosthetic infection in most domestic and foreign hospitals. This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months. Purpose To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints. Materials and methods Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years). Results Out of 113 two-stage procedures of hip joint revision, 102 (90.2%) cases showed an arrest of infection. Four (3.6%) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6%) rejected to replace the spacer with an implant, and three (2.6%) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3%) cases; eight (13.4%) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6%) had a two-stage repeated revision. Conclusions Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7% (83.3% for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8% for hip and 16.7 % for knee joints).

Procedure for single-stage implant retention for chronic periprosthetic infection using topical degradable calcium-based antibiotics.

Surgical treatment using DAIR (debridement, systemic antibiotics, and implant retention) can lead to high rates of treatment success in cases of early periprosthetic joint infection (PJI) but can fail in late-onset cases. Supplementary local antibiotic therapy is not yet generally established and lacks evidence-based proof of efficacy. The aim of this study was to analyze DAIR outcomes in recurrent PJI cases and patients who are not suitable for a two-stage exchange, using additional degradable calcium-based antibiotics. All patients fulfilled the Infectious Diseases Society of America (IDSA) guidelines for chronic late-onset PJI but were not suitable for a multistage procedure because of their individual operation risk. A total of 42 patients (mean age, 73years) were treated using a single-stage algorithm consisting of DAIR, followed by implantation of degradable antibiotics chosen in accordance with an antibiogram. OSTEOSET® (admixed ceftriaxone/vancomycin/tobramycin) and Herafill-Gentamycin® were used as carrier systems. The follow-up period was 23months (± SD, 10.3). The study is based on institutional review board (IRB) approval. The clinical entities were chronic PJI of the hip (45.2%), knee (28.6%), and knee arthrodesis (26.2%). The bacterial spectrum was composed of Staphylococcus epidermidis (29%), Staphylococcus aureus (21%), and Enterococcus faecalis (21%). 21.4% showed a combination of two or more bacteria. In 73.8%, permanent remission was achieved, while 11.9% showed chronic PJI under implant retention. Implant retention could be achieved in 85.7%. DAIR usually shows low levels of success in difficult-to-treat cases. However, we could demonstrate the successful treatment of patients with recurrent PJI (typically considered DAIR-inappropriate) using degradable antibiogram-based topical calcium-based antibiotics. Over 70% of the cases went to remission and over 85% of the implants could be retained.

Gastrocnemius Myocutaneous Flaps for Knee Joint Coverage.

The gastrocnemius muscular flap has already proven its efficiency for soft tissue coverage in cases of knee joint exposure. However, it may be too small to cover large defects and has not the same aesthetic and mechanical properties as normal skin. Perforator fasciocutaneous flaps have recently been described in knee joint coverage with good results as they replace skin by skin, but they can be hard to harvest. Gastrocnemius flaps can be easily harvested with a planned skin paddle designed over the chosen muscle. This simple technique combines the advantages of muscular and fasciocutaneous flaps for knee joint area coverage. Perforator fasciocutaneous flap take a growing place in coverage of this localization in recent literature, but very few articles report the results of gastrocnemius myocutaneous flaps (MCFs). All patients who underwent knee joint coverage with the use of a lateral or medial gastrocnemius MCFs between January 2012 and February 2017 in our university institution were included in this retrospective study. Sixteen gastrocnemius MCFs (10 medial and 6 lateral) were performed. The indication was posttraumatic in 5 cases, posttumoral in 5 cases, and after total knee prosthesis exposure in 6 cases. Skin paddles up to 15 cm in width and 18 cm in length were harvested. Complete healing was achieved in 15 days in all cases without suffering or nonunion. Three flaps were secondarily raised to allow total knee prosthesis reimplantation or arthrodesis, and 4 patients were treated with postoperative radiotherapy without complication. In addition to its reliability and very easy harvesting, the gastrocnemius MCF allows a robust joint coverage and good skin resurfacing that makes eventual revision easier and allows early radiotherapy. Furthermore, skin paddle also increases the effective area of the flap. This technique should always be considered with the other classic alternatives.

Allograft of the knee extensor in cases of patellar tendon rupture in total arthroplasty patients

ObjectiveRetrospective study to evaluate the functional results of patients with total knee arthroplasty and rupture of the patellar tendon, submitted to transplantation of the extensor knee apparatus with fresh frozen allograft. MethodNine patients, operated between 2003 and 2015, with a minimum of one year of follow-up. All patients were reviewed by performing a functional evaluation using the Knee Society score. Preoperative values were compared with those of the final evaluation. ResultsMean survival was 2.7±1.9 years (14–1). The knee score improved from 38±4.5 to 70±8.5, and functional score from 30±6.5 to 90±3.5. Mean extension deficit was 5 (1–15). Mean range of motion was 80 (60–100). ConclusionThe use of allograft is a solution for extreme cases of patellar rupture after total knee arthroplasty, providing reasonable functional results and representing an alternative to knee arthrodesis.

Higher failure rate of two-stage revision for infected knee arthroplasties in significantly compromised (host-C) patients.

To evaluate clinical outcomes of two-stage revision arthroplasty for managing infected knee arthroplasties in significantly compromised patients (host-C). This was a prospective consecutive series of two-stage revisions of infected total knee arthroplasties in host-C-type patients with a minimum 2-year follow-up using objective and patient-reported outcome measures. Thirteen consecutive patients were included and prospectively followed with a median 5-year follow-up (range 2-10). Median age was 68years (range 59-73) at time of initial presentation. All patients were type-C host using McPherson classification system. All patients had primary arthroplasties in situ with confirmed chronic infections; the infecting pathogens were Staphylococcus aureus in 5/13 patients, coagulase-negativeStaphylococci in 5/13, and the remaining three patients had mixed growth. All patients underwent two-stage revision protocol. At the final follow-up, 9/13 patients were infection free achieving satisfactory outcomes. Two patients had recurrent infections with different organisms and treated with suppressive antibiotics and salvage knee arthrodesis, respectively. Furthermore, two patients had chronic pain and poor functional outcomes with deficient extensor mechanism and significant bone loss; later underwent salvage knee arthrodesis. The preoperative knee society score (median 35.5; range 22-51; n = 10) showed a statistically significant improvement at the final follow-up (median 79.5; range 49-87; n = 10) p < 0.05. Patients reported outcome scores at the final follow-up were WOMAC-knee (median 59.1; range 47.7-94.7; n = 13) and Oxford knee score (median 26; range 11 to 43; n = 13). This study highlights the challenge of treating infected knee arthroplasties in physiologically compromised patients with 9/13 (69%) having satisfactory clinical outcomes. Case series, level IV.

Knee Arthrodesis Outcomes After Infected Total Knee Arthroplasty and Failure of Two-stage Revision With an Antibiotic Cement Spacer.

Background:Reinfected total knee arthroplasty can be managed with a second two-stage exchange or a knee arthrodesis procedure.Methods:Twenty-three patients with knee arthrodesis after failed exchange arthroplasty for infection were reviewed. Patients were managed with a staged protocol of implant extraction, débridement, and implantation of an antibiotic spacer, with subsequent arthrodesis. Follow-up averaged 40.4 months, with a minimum of 1 year.Results:Bony union with eradication of infection was achieved in 20/23 knees. Sixteen of the 20 patients were able to ambulate with minimal pain. The average time to union was 11.3 months, and the average leg length discrepancy was 4.85 cm. The average Knee Society Score after arthrodesis was 44, and the average visual analog scale pain score was 1.73. Three patients underwent above-knee amputation.Discussion:Knee arthrodesis performed for persistent periprosthetic infection allowed for eradication of infection and union in 87% of the patients, creating a stable knee fusion.

Management of infected total knee arthroplasty by Ilizarov fixator

Introduction Persistent infection after total knee arthroplasty (TKA) is a very serious complication. Arthrodesis is considered if the prosthesis cannot be retained or revision surgery is obviated. The purpose of this study was to evaluate the radiological and functional results of knee arthrodesis with Ilizarov external fixator to treat infected TKA. Patients and methods This was a retrospective study of 13 patients with infected TKA treated by implant removal, debridement, and fusion by Ilizarov fixator operated from October 2010 to March 2015. The study included nine females and four males with a mean age of patients of 64.08 years. Seven patients were diabetics and two had a past history of deep venous thrombosis. Time, from the primary TKA till knee fusion, ranged from 18 to 37 months. All patients had previous surgical interventions with a mean of 4.62 procedures. Eleven patients had draining sinuses. In addition to clinical and radiographic evaluation, the functional assessment was done by Western Ontario and McMaster Universities Osteoarthritis index questionnaire. Results Patients were followed up for a mean of 28.62 months. The mean external fixator period was 7.77 months. Postoperative hematoma occurred in one patient. Pin track infection occurred in 10 cases. All cases had successful fusion except two patients and infection was controlled in all cases. The mean leg length discrepancy was 3.96 cm. The mean postoperative Western Ontario and McMaster Universities Osteoarthritis index score was 30.08. Conclusion Knee arthrodesis by Ilizarov external fixator for treating persistently infected TKA achieved high fusion and infection control rates and provided a stable limb with pain relief and functional improvement.

Management of infected supracondylar femoral nonunion with bone loss by primary knee arthrodesis with hybrid Ilizarov frame: a study of 10 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Most of infected nonunion supracondylar femur with bone loss is a challenge to orthopedicians, where amputation is one of the choice. Opinions are divided on the appropriate management of infected nonunion supracondylar femur with bone loss. Evidence supports for both, osteosynthesis with or without salvaging knee joint and above knee amputation.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;10 consecutive patients at Nizam’s Institute of Medical Sciences, from Jan 2013 to December 2016, who underwent limb salvage with knee arthrodesis for infected nonunion supracondylar femur with bone loss were evaluated and followed till union. Treatment option in the form of osteosynthesis with knee arthrodesis was achieved with hybrid Ilizarov fine wire fixator. The hybrid Ilizarov frame comprised of conventional two ring tibial frame and one ring and one Italian arch in the femoral segment with half treaded pins, this construct was chosen because of less weight, less cumbersome without compromising the stability and basic features&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;All patients went for solid knee arthrodesis in functional position, with a mean fusion time of 22.4 ± 4.97 weeks. The time interval between primary surgery and definitive treatment was 15.6 ± 6.37 weeks. The mean shortening of lower limb was 3.1±1.19 cms. To achieve arthrodesis quickly, it’s necessary to have light weight, compact Ilizarov frame, have good bone to bone contact and allow early full weight bearing. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Osteosynthesis with knee arthrodesis in cases of infected nonunion supracondylar femur with bone loss is a viable option in select cases where the patient is physiologically young, has undergone several procedures around the knee and the knee is stiff. Fusion of the knee enables quick restoration of the patient to his work place.&lt;/span&gt;&lt;/p&gt;

Knee Arthrodesis in a Patient with Charcot Neuroarthropathy Secondary to Familial Amyloid Polyneuropathy: A Case Report.

We report a rare case of severe Charcot neuroarthropathy of the knee secondary to familial amyloid polyneuropathy, which was treated surgically with a knee arthrodesis. This treatment allowed an early symptomatic and functional improvement and a short consolidation time without any major complications. Neuropathy is the earliest and most major burden in patients with familial amyloid polyneuropathy; it requires careful evaluation and adequate treatment aimed at preventing or slowing the progression of secondary damage, involving Charcot neuroarthropathy, that may occur. Surgical arthrodesis with antegrade intramedullary nailing may be appropriate in a patient with severe Charcot neuroarthropathy of the knee.

Knee arthrodesis versus above-the-knee amputation after septic failure of revision total knee arthroplasty: comparison of functional outcome and complication rates

BackgroundAfter septic failure of total knee arthroplasty (TKA) and multiple revision operations resulting in impaired function, bone and/or soft-tissue damage a reconstruction with a revision arthroplasty might be impossible. Salvage procedures to regain mobility and quality of life are an above-the-knee amputation or knee arthrodesis. The decision process for the patient and surgeon is difficult and data comparing arthrodesis versus amputation in terms of function and quality of life are scarce. The purpose of this study was to analyse and compare the specific complications, functional outcome and quality of life of above-the-knee amputation (AKA) and modular knee-arthrodesis (MKA) after septic failure of total knee arthroplasty.MethodsEighty-one patients treated with MKA and 32 patients treated with AKA after septic failure of TKA between 2003 and 2012 were included in this cohort study. Demographic data, comorbidities, pathogens and complications such as re-infection, implant-failure or revision surgeries were recorded in 55MKA and 20AKA patients. Functional outcome with use of the Lower-Extremity-Functional-Score (LEFS) and the patients reported general health status (SF-12-questionnaire) was recorded after a mean interval of 55 months.ResultsA major complication occurred in more than one-third of the cases after MKA and AKA, whereas recurrence of infection was with 22% after MKA and 35% after AKA the most common complication. Patients with AKA and MKA showed a comparable functional outcome with a mean LEFS score of 37 and 28 respectively (p = 0.181). Correspondingly, a comparable physical quality of life with a mean physical SF-12 of 36 for AKA patients and a mean score of 30 for MKA patients was observed (p = 0.080). Notably, ten AKA patients that could be fitted with a microprocessor-controlled-knee-joint demonstrated with a mean LEFS of 56 a significantly better functional outcome than other amputee patients (p < 0.01) or MKA patients (p < 0.01).ConclusionNaturally, the decision process for the treatment of desolate situations of septic failures following revision knee arthroplasty is depending on various factors. Nevertheless, the amputation should be considered as an option in patients with a good physical and mental condition.

Transplante de aloenxerto de aparelho extensor do joelho em casos de rotura do tendão patelar em pacientes com artroplastia total

ObjectiveRetrospective study to evaluate the functional results of patients with total knee arthroplasty and rupture of the patellar tendon, submitted to transplantation of the extensor knee apparatus with fresh frozen allograft. MethodNine patients, operated between 2003 and 2015, with a minimum of one year of follow‐up. All patients were reviewed by performing a functional evaluation using the Knee Society score. Preoperative values were compared with those of the final evaluation. ResultsMean survival was 2.7 ± 1.9 years (14‐1). The knee score improved from 38 ± 4.5 to 70 ± 8.5, and functional score from 30 ± 6.5 to 90 ± 3.5. Mean extension deficit was 5° (1° ‐ 15°). Mean range of motion was 80° (60‐100). ConclusionThe use of allograft is a solution for extreme cases of patellar rupture after total knee arthroplasty, providing reasonable functional results and representing an alternative to knee arthrodesis.

Risk Factors for Repeat Debridement, Spacer Retention, Amputation, Arthrodesis, and Mortality After Removal of an Infected Total Knee Arthroplasty With Spacer Placement

BackgroundChronic periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is most commonly addressed with a 2-stage exchange procedure. The purpose of this study is to examine the natural history of patients who have undergone prosthesis removal and spacer placement and evaluate risk factors for outcomes other than reimplantation. MethodsPatients who underwent removal of an infected TKA and placement of an antibiotic spacer for PJI were identified in a Medicare database. Patients with a study outcome within 1 year were then identified: (1) in hospital mortality, (2) knee arthrodesis, (3) amputation, (4) repeat debridement procedure without reimplantation, and (5) reimplantation. Independent risk factors for these outcomes were evaluated with a multivariate logistic regression analysis. ResultsA total of 18,533 patients were included. Within 1 year postoperatively, 691 patients (3.7%) died in a hospital setting, 852 patients (4.5%) underwent a knee arthrodesis, 574 patients (3.1%) underwent an amputation, 2683 patients (14.5%) underwent a repeat debridement procedure without being reimplanted, 2323 patients (12.5%) retained their spacer, and 11,420 patients (61.6%) underwent spacer removal and reimplantation within 1 year. Numerous independent patient-related risk factors for these outcomes were identified. ConclusionA large number of patients (38.4%) do not undergo reimplantation within 1 year of prosthesis removal and spacer placement. Outcomes after prosthesis removal and antibiotic spacer placement are variable, and there are several independent risk factors for such outcomes that may be used to develop and improve existing treatment strategies for patients presenting with chronic PJI after TKA.

Radiographic and Functional Outcomes following Knee Arthrodesis Using the Wichita Fusion Nail.

The purpose of this study was to report both the radiographic and functional outcomes of patients undergoing knee arthrodesis with the Wichita Fusion Nail (WFN) within the Republic of Ireland and compare the results to existing literature. Patient charts and radiographs were reviewed on all patients who had a WFN implanted in Ireland to date. Patients were invited to complete a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score as a functional assessment. Twenty-three patients were identified. Patients had an average of 8 (range: 0-26) knee surgeries prior to arthrodesis. The most common indication was failed arthroplasty due to recalcitrant infection (69.5%). Successful fusion occurred in 60.8% of patients. The mean time to fusion was 9.21 months. The mean WOMAC score was 58.55 with a range of 31 to 96. We found a rate of arthrodesis lower than that reported in other published series. However, the rate of major complications was comparable to those published previously, reflecting the often-challenging patient cohort. Our study shows that the WFN should not be viewed as a near-universally successful option to salvage an unreconstructable knee.

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

BackgroundPeriprosthetic 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. MethodsThirty 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. ResultsThirty 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 2.2cm. The mean VAS for pain was three, the mean Oxford Knee Score was 38±9. Total implant survival at a 74month 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. ConclusionsSeptic 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.

Knee joint arthrodesis in non-specific purulent osteoarthritis using external fixation device

In case of failure of conservative treatment in patients with non­specific purulent osteoarthritis (NPOA) different surgical tech­niques can be used, including knee arthrodesis. Today various external fixators (EFD) for the joint arthrodesis are widely used. Objective:to evaluate the results of surgical treatment of knee joint NPOA using the combined device of transosseous fixation. Methods: it is proposed to use incomplete rings (¾ of circumference) reduce limb weight action on EFD elements. It is provided a mechanical testing of osteosynthesis rigidity in the case of de­veloped EDF compared with ring pin-wire device in operated 24 patients (19 men and 5 women, age 24 to 76 years) with knee NPOA. Follow-up was 1, 3, 6 and 12 months. Results: indicators of osteosynthesis rigidity in the case of the modified EFD and pin-wire external device had insignificant difference, which al­lowed to apply it for joint arthrodesis without losing the strength of fixation. Ankylosis obtained in 21 (95.5%) patients. The aver­age term of fixation was (3.5 ± 0.5) month, the mean limb shortening — (2.0 ± 0.5) cm. Persistent halt of inflammation obtained in 22 patients, full weight-bearing recovery — in 21 (95.5 %). Quality of life improved in all patients. The average data of visual analogue scale (VAS) decreased from 8 (before surgery) to 3.1 (af­ter). Conclusions: transosseous osteosynthesis in the treatment of patients with nonspecific purulent osteoarthritis of the knee joint is currently the treatment of choice. Used one-step arthrodesis technique of the knee joint with purulent osteoarthritis using modified EFD allowed to earlier patients ambulation, contributed to inhibition of inflammatory processes and weight-bearing recovery.

Knee arthrodesis using Ender nails and bone cement after prosthetic joint removal in 2 cases of rheumatoid arthritis

Knee arthrodesis using Ender nails and bone cement after prosthetic joint removal in 2 cases of rheumatoid arthritis