Removal of infected cemented hinge knee prostheses using extended femoral and tibial osteotomies: Six cases

Abstract

Extended femoral and tibial osteotomies were performed to remove infected cemented hinged knee prostheses in five patients (six knees) with a mean age of 72 years (44-85) and a history of multiple knee surgeries. A tibial osteotomy was used to mobilise the distal quadriceps insertion and to release the tibial extension. The femoral component was extracted by downward traction and its cement mantle was cleared through an anterior osteotomy (n=4) or via the distal approach (n=2). The bone flaps were re-approximated by wire cerclage over articulating acrylic spacers. Mean time to re-implantation of a new knee prosthesis was 11 months (6-24). Revision prostheses with cement fixation restricted to the epiphyseal-metaphyseal region were used. Infection recurred in two cases at 16 and 4 months after the prosthetic re-implantation, and was managed by joint fusion for one and irrigation/lavage for the other, respectively. At last follow-up after a mean of 53 months, the mean Parker score was 4 ± 2, the mean IKS knee score was 66 ± 25 (28-93), and the mean IKS function score was 7 ± 16 (0-40). This technique facilitates the removal of infected cemented components of hinge prostheses and of the cement mantle, most notably in the absence of loosening, without compromising re-implantation of a new knee prosthesis.

Total knee arthroplasty using hinge joints: Indications and results

“…In 2012, Massin et al reported six cases of removal of infected cemented hinge knee prostheses using extended femoral and tibial osteotomies. 64 This procedure facilitated the removal of infected cemented components and of the cement mantle, mainly in the absence of loosening, without compromising re-implantation of a new knee prosthesis.…”

Removal of Well-Fixed Tibial Cone in Revision Total Knee Arthroplasty—A Uniquely Challenging Yet Necessary Scenario

“…The authors also emphasized the importance of preoperative planning and obtaining the manufacturer's manual when removing complex implants. Massin et al 15 described an alternative technique of extended cortical tibial and femoral osteotomies to remove cemented hinged knee prostheses in a series of six patients. In this technique, an oscillating saw is used to release a pedicled anterior bone flap (averaging around 15 cm in length) flush with the anterior aspect of the tibial stem.…”

“…Additionally, the osteotomy affords improved access to the cement mantle around the stem, as well as the bone-implant interface, of the cone. 14,15 This can be instrumental in freeing the stem to allow safe removal.…”

Anterolateral Oblique Distal Femoral Osteotomy for the Removal of Well Fixed Cemented Femoral TKA Components

“…The removal of well-fixed implants with cemented stems about the knee presents unique challenges in revision and resection knee arthroplasty. [1][2][3] Extended trochanteric osteotomies and tibial tubercle osteotomy for revision hip and knee arthroplasty have been previously described and used effectively for the removal of implants in these settings. [4][5][6][7][8] Anterior femoral osteotomy in revision knee arthroplasty has been previously described, however many of these reports do not outline the specific technique utilized or markedly compromise blood flow to the osteotomized fragment.…”

“…[4][5][6][7][8] Anterior femoral osteotomy in revision knee arthroplasty has been previously described, however many of these reports do not outline the specific technique utilized or markedly compromise blood flow to the osteotomized fragment. [1,9] These techniques were utilized in small groups of patients with limited follow up.…”