Dataset Information

Arthrodesis After Infected Revision TKA: Retrospective Comparison of Intramedullary Nailing and External Fixation.

ABSTRACT:

Background

Infection after revision total knee arthroplasty (TKA) for previous septic TKA can be a challenging problem to treat due to loss of bone stock and soft tissue integrity. In these cases, arthrodesis is a well-recognized salvage procedure.

Questions/purposes

The aim of this retrospective study was to compare the results as described by a Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score (LAS) of knee arthrodeses performed by using either an external fixator (EF) or an intramedullary nail (IM).

Methods

The study included 34 knee arthrodesis divided in two groups: first group included 12 patients treated with EF and the second group of 22 patients dealt with IM nail. Clinical and functional evaluation was performed using the VAS and the LAS. Full-length radiographs were used to verify limb length discrepancy.

Results

VAS and LAS results showed a substantial improvement relative to preoperative condition in both groups. However, the LAS was significantly better in the IM nail group. The mean leg length discrepancy was significantly greater (4.5 cm) in the first group than in the second one (0.8 cm). No recurrence of infection was observed in the EF group while there were three recurrent infections in the IM nail group.

Conclusion

Our study supported the existing literature and found that reinfection after revision TKA can be effectively treated with arthrodesis. In presence of massive bone loss, we recommend arthrodesis with IM nail used as an endoprosthesis, without bone-on-bone fusion, to produce a stable and painless knee, while preserving the limb length. Use of an IM nail allowed us to get a better functional result than EF.

SUBMITTER: Iacono F

PROVIDER: S-EPMC3772168 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

Arthrodesis After Infected Revision TKA: Retrospective Comparison of Intramedullary Nailing and External Fixation.

Iacono Francesco F Raspugli Giovanni Francesco GF Bruni Danilo D Lo Presti Mirco M Sharma Bharat B Akkawi Ibrahim I Marcacci Maurilio M

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20130814 3

<h4>Background</h4>Infection after revision total knee arthroplasty (TKA) for previous septic TKA can be a challenging problem to treat due to loss of bone stock and soft tissue integrity. In these cases, arthrodesis is a well-recognized salvage procedure.<h4>Questions/purposes</h4>The aim of this retrospective study was to compare the results as described by a Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score (LAS) of knee arthrodeses performed by using either an external fixato ...[more]

PMID: 24426874

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Project description:ObjectiveTo explore the clinical effect of antibiotic artificial bone implantation and external fixation in the treatment of infection after intramedullary nail fixation.MethodsWe retrospectively reviewed the clinical data of patients with infection after intramedullary nail fixation treated from March 2010 to August 2020. There were 27 males and 6 female, aged from 12 to 67 years (average 42.27 years), 18 cases on the left side and 15 cases on the right side. Among them, 20 cases were open fractures with initial injury and 13 cases were closed fractures. All patients were treated with intramedullary nail removal, local debridement, antibiotic artificial bone implantation and external fixation. Because of bone defects, 19 patients underwent secondary autologous cancellous bone grafting after infection control. Postoperative wound healing, related inflammatory indicators, fixation time, and bone healing time were recorded and followed up.ResultsThe 33 patients were followed up with period of 10 ~ 98 months (average 62.7 months). One patients failed to control the infection effectively after treatment, so received antibiotics artificial bone implantation again. Two patients also received antibiotic artificial bone implants again due to the recurrence of the infection. After treatment, infection was controlled and the fracture healed well. One patient received vacuum sealing drainage (VSD) due to persistent postoperative exudation, and five patients were also cured successfully after continuous dressing. Two patients had sinus tract after surgery, and the wound was cured by continuous dressing change. Nineteen patients received autogenous iliac bone grafts for healing due to bone defects ranging from 3 to 6.5 cm (average 4.15 cm) after infection control. The external fixation time of 33 patients ranged from 4 to 16 months (average 7.79 months), the bone healing time ranged from 4 to 13 months (average 6.67 months), and the related inflammatory indexes returned to normal within 2-8 weeks (average 4.48 weeks).ConclusionAntibiotic artificial bone implantation and external fixation is an effective method for the treatment of infection after intramedullary nail fixation.

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Dataset Information

Arthrodesis After Infected Revision TKA: Retrospective Comparison of Intramedullary Nailing and External Fixation.

Background

Questions/purposes

Methods

Results

Conclusion

Publications

Arthrodesis After Infected Revision TKA: Retrospective Comparison of Intramedullary Nailing and External Fixation.

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