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External fixator arthrodesis antibiotic spacer in two-stage revision total knee arthroplasty for eradication of periprosthetic joint infection.

ABSTRACT: Two-stage revision total knee arthroplasty remains the gold standard for management of chronic periprosthetic joint infection in North America. Static cement antibiotic spacers used after knee resection to deliver high-dose antibiotics lack primary stability, potentially leading to spacer migration or dislocation, additional bone loss, extensor mechanism erosion, and even knee subluxation or frank dislocation. A custom brace or cast is often required to augment knee stability, which is time-consuming, costly, and prevents monitoring or wound care of the soft tissues. An external fixator arthrodesis antibiotic spacer can provide primary stability without a brace or cast, allowing for soft-tissue monitoring and care, and minimizes potential spacer complications. We present the technique for implanting and removing this specific external fixator arthrodesis antibiotic spacer.

SUBMITTER: Chalmers BP

PROVIDER: S-EPMC6728769 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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External fixator arthrodesis antibiotic spacer in two-stage revision total knee arthroplasty for eradication of periprosthetic joint infection.

Chalmers Brian P BP Hernandez Nicholas M NM Yuan Brandon J BJ Abdel Matthew P MP Lewallen David G DG Perry Kevin I KI

Arthroplasty today 20190327 3

Two-stage revision total knee arthroplasty remains the gold standard for management of chronic periprosthetic joint infection in North America. Static cement antibiotic spacers used after knee resection to deliver high-dose antibiotics lack primary stability, potentially leading to spacer migration or dislocation, additional bone loss, extensor mechanism erosion, and even knee subluxation or frank dislocation. A custom brace or cast is often required to augment knee stability, which is time-cons ...[more]

PMID: 31516972

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Project description:ObjectivesA periprosthetic joint infection (PJI) is a significant complication after total knee arthroplasty (TKA). Still there is no agreement on a perfect diagnosis and treatment algorithm. The aim of this study was to evaluate the success and revision rates after two-stage revision total knee arthroplasty (TKA) and factors that affect the success rate.Material and methods50 consecutive two-stage revision TKAs were performed between January 2011 and December 2012. We retrospectively reviewed study patient's charts including demographics, prior surgeries, comorbidities, incidence of persistent infection and revisions. At the final follow-up examination the patient's satisfaction, pain level and disorders were evaluated. A successful clinical outcome was defined as a functioning prosthesis without wound healing disorders, no sinuses tracts or other clinical evidence of a persistent infection. Results : Re-implantation of prosthesis was performed in 47 cases; three patients received a septic arthrodesis. Twelve patients had a persistent infection despite two-stage re-implantation resulting in a success rate of 76.0%. In eight of these twelve patients an infecting germ was isolated during second-stage procedure. Three patients received another two-stage revision arthroplasty and one patient an above knee amputation. A revision was performed in 23 of 50 patients (46.0%). Factors that diminish the success rate were further operations after primary TKA (p = 0.048), prior revision arthroplasties after TKA (p = 0.045), nicotine abuse (p = 0.048), Charlson comorbidity index above a score of 2 (p = 0.031) and a mixed flora during first-stage procedure (p < 0.001). Age, sex, immune status, chronic anticoagulant use, rheumatoid arthritis, body mass index and the presence of multidrug resistant germs showed no significant effect on success rate (p > 0.05). Conclusion : We found that patients who required surgery after the primary TKA, had a higher Charlson comorbidity index or were found to have mixed flora during explantation. The treatment of PJI remains difficult, both for the patient and for the treating surgeons.

Dataset Information

External fixator arthrodesis antibiotic spacer in two-stage revision total knee arthroplasty for eradication of periprosthetic joint infection.

Publications

External fixator arthrodesis antibiotic spacer in two-stage revision total knee arthroplasty for eradication of periprosthetic joint infection.

Similar Datasets

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