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

Abstract

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.

Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature

“…Studies in the literature have reported on three different silver-coated MPs [ 97 ], with most of the data coming from oncologic patient series. Fiore et al [ 98 ] highlighted that silver-coated implants are particularly useful in two-stage revisions for infection and in patients with incidental positive cultures at the time of prosthesis implantation [ 64 , 98 , 99 , 100 , 101 , 102 ]. On the other hand, the results of silver-coated MPs in PJI prevention are extremely heterogeneous.…”

Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis

“…Empirical intravenous broad-spectrum antibiotic therapy is generally begun immediately after surgery. After culture results, antibiotic therapy is modified, using an oral regimen whenever possible [ 10 ].…”