Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator—a series of one hundred fifty two patients

Suda, Arnold J.; Brachtendorf, Xaver; Tinelli, Marco; Wagokh, Raed; Abou-Nouar, Ghaith; Bischel, Oliver

doi:10.1007/s00264-021-05054-w

Cited by 3 publications

(4 citation statements)

References 49 publications

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“…Overall, the preoperative VAS score was evaluated in three studies [18,20,28] involving a total of 91 patients, with a mean value of 5.1 ± 3.5. In eight studies [3,4,16,19,24,25,28], the postoperative VAS score was evaluated in 217 patients, with a mean value of 2.7 ± 2.2, and a statistically significant difference was found (p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Fusion was defined as bony trabeculae traversing from the tibia to the femur in at least two radiographic projections. It was reported after IMN in nine studies [8,15,21,22,24,29,[31][32][33] and occurred in 192 out of 267 patients (71.9%). In the EF group, fusion was reported in seven studies [13,14,16,20,24,26,29] and occurred in 130 out of 165 (78.8%) patients.…”

Section: Fusion Reoperation and Amputation Ratesmentioning

confidence: 97%

“…It was reported after IMN in nine studies [8,15,21,22,24,29,[31][32][33] and occurred in 192 out of 267 patients (71.9%). In the EF group, fusion was reported in seven studies [13,14,16,20,24,26,29] and occurred in 130 out of 165 (78.8%) patients. Fusion after CP was reported in two studies [13,29] and occurred in 12 out of 13 patients (92.3%).…”

Section: Fusion Reoperation and Amputation Ratesmentioning

confidence: 97%

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Knee Arthrodesis for Periprosthetic Knee Infection: Fusion Rate, Complications, and Limb Salvage—A Systematic Review

Mercurio,

Gasparini,

Cofano

et al. 2024

Healthcare

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The aim of this systematic review was to investigate the outcomes of knee arthrodesis (KA) after periprosthetic joint infection (PJI) of the knee. Differences in clinical outcomes and complication rates among the intramedullary nailing (IMN), external fixation (EF), and compression plating (CP) procedures were compared. A total of 23 studies were included. Demographics, microbiological data, types of implants, surgical techniques with complications, reoperations, fusion, and amputation rates were reported. A total of 787 patients were evaluated, of whom 601 (76.4%), 166 (21%), and 19 (2.4%) underwent IMN, EF, and CP, respectively. The most common causative pathogen was coagulase-negative Staphylococcus (CNS). Fusion occurred in 71.9%, 78.8%, and 92.3% of the patients after IMN, EF, and CP, respectively, and no statistically significant difference was found. Reinfection rates were 14.6%, 15.1%, and 10.5% after IMN, EF, and CP, respectively, and no statistically significant difference was found. Conversion to amputation occurred in 4.3%, 5%, and 15.8% of patients after IMN, EF, and CP, respectively; there was a higher rate after CP than after EF. The IMN technique is the most common option used for managing PJI with KA. No differences in terms of fusion, reinfection, or conversion-to-amputation rates were reported between IMN and EF. CP is rarely used, and the high amputation rate represents an important limitation of this technique.

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Section: Resultsmentioning

confidence: 99%

Section: Fusion Reoperation and Amputation Ratesmentioning

confidence: 97%

Section: Fusion Reoperation and Amputation Ratesmentioning

confidence: 97%

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Knee Arthrodesis for Periprosthetic Knee Infection: Fusion Rate, Complications, and Limb Salvage—A Systematic Review

Mercurio,

Gasparini,

Cofano

et al. 2024

Healthcare

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“…Driven by the demand for better healing of long bone fractures, ideal INs should have appropriate mechanical strength for initial stability, excellent biological activity and biodegradation properties for bone growth [10,11]. In the past few years, calcium silicate (CSi) ceramics have been extensively studied for use as implants in bone repair due to their excellent osteoconductivity and osteoinductivity [12,13].…”

Section: Introductionmentioning

confidence: 99%

Magnesium-Containing Silicate Bioceramic Degradable Intramedullary Nail for Bone Fractures

Shao

Jing

et al. 2022

Crystals

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Intramedullary nails (INs) have significant advantages in rigid fracture fixation. Due to the stress shielding effect and lack of biological activity, traditional metal INs often lead to delay union or nonunion fracture healing. Undegradable metals also need to be removed by a second surgery, which will impose a potential risk to the patient. Current degradable biomaterials with low strength cannot be used in INs. Manufacturing high-strength biodegradable INs (BINs) is still a challenge. Here, we reported a novel high strength bioactive magnesium-containing silicate (CSi-Mg) BIN. This BIN is manufactured by using casting, freeze drying, and sintering techniques and has extremely high bending strength and stable internal and external structures. The manufacturing parameters were systematically studied, such as the paste component, freeze-drying process, and sintering process. This manufacturing method can be applied to various sizes of BINs. The CSi-Mg BIN also has good bioactivity and biodegradation properties. This novel bioactive BIN is expected to replace the traditional metal INs and become a more effective way of treating fractures.

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The use of antibiotic-loaded bone cement combined with tibial intramedullary nail as last resort treatment in 11 elderly patients with knee joint bone infection

Li,

Zhang,

et al. 2024

Preprint

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Background The management of bone infections has always posed a challenge in the field of orthopedics, and geriatric knee joint bone infections are even more difficult. In this study, we aimed to assess the clinical efficacy of using antibiotic-loaded bone cementcombined with tibial intramedullary nail as a last resort treatment option for geriatric knee joint bone infection patients. Methods The retrospective study was conducted on 11 elderly patients with knee joint bone infection. The cohort comprised 3 male and 8 female patients, with an average age of 74.27±3.47years. Of these patients, 4 patients experienced reinfection after knee revision replacement, while 7 patients had knee joint bone infection.After stage-1 infection control, all patients underwent a stage-2 treatment using antibiotic-loaded bone cement combined with tibial intramedullary nail as the ultimate treatment approach. Results All patients’ infections were effectively controlled. The average length of bone defect after debridement was 12.09±1.22cm. The duration of the stage-2 operation averaged180.27±11.06minutes. Postoperatively, there was no significant discrepancy in the length of the patients’ lower limbs. All patients experienced a significant enhancement in knee joint function, as indicated by the decrease in WOMAC scores from 141.45±11.75preoperatively to 79.09±0.34postoperatively. Pain levels saw a profound reduction, plummeting from 26.27 ± 2.45 to a non-existent 0.00 ± 0.00. Additionally, there was a substantial improvement in performing daily activities, rising impressively from 59.09 ± 0.34 to 100.55 ± 8.37. However, an increase in joint stiffness was noted, worsening slightly from 15.45 ± 1.63 to 20.00 ± 0.00.One case of peri-implant fracture occurred. Conclusion Antibiotic-loaded bone cement combined with tibial intramedullary nailing as last resort treatment can be considered as an alternative surgical option for elderly patients with knee joint bone infection who have experienced multiple failed operations and long-term knee stiffness.

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Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator—a series of one hundred fifty two patients

Cited by 3 publications

References 49 publications

Knee Arthrodesis for Periprosthetic Knee Infection: Fusion Rate, Complications, and Limb Salvage—A Systematic Review

Knee Arthrodesis for Periprosthetic Knee Infection: Fusion Rate, Complications, and Limb Salvage—A Systematic Review

Magnesium-Containing Silicate Bioceramic Degradable Intramedullary Nail for Bone Fractures

The use of antibiotic-loaded bone cement combined with tibial intramedullary nail as last resort treatment in 11 elderly patients with knee joint bone infection

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