Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects

Abstract

Retrospective case series, Level IV.

Inadequacy of Joint Aspiration for Detection of Persistent Periprosthetic Infection During Two-Stage Septic Revision Knee Surgery

“…In the study department, the standard surgical technique for first-stage surgery includes synovial aspiration before capsulotomy, acquisition of 5 periprosthetic tissue samples, sampling of the peripros-thetic membrane for histologic analysis, complete synovectomy, debridement of osseous surfaces, and lavage of the joint space with 0.04% polihexanid (Serasept; Serag-Wiessner KG, Naila, Germany). 14 Temporary knee arthrodesis was performed with a customized gentamicinloaded polymethylmethacrylate (PMMA) spacer reinforced with 2 steel tubes, allowing for intramedullary femoral and tibial fixation, with a standard technique that was published previously. 14 After intraoperative acquisition of microbiologic samples, intraoperative antibiotic prophylaxis was initiated with 2 g cefazolin and continued postoperatively with intravenous administration of 3 g sultamicillin 3 times daily.…”

Modern Techniques in Knee Arthrodesis

“…Over a mean follow-up period of 56.4 months, a 30% complication rate was noted (range of 11.4%-81.8% from past studies) (Table 1) and a 90% (9 of 10 patients) survivorship of the arthrodesis was recorded with no evidence of residual infection or prosthesis failure [12,22,28,29,33] . One out of the ten patients experienced a recurrent infection which fell in the range of persistent or recurrent infection rates (0-45.5%) seen in past studies [12,13,20,22,28,33] (Table 1). …”

“…A successful knee arthrodesis procedure is commonly evaluated based on a number of factors including: high rate of union, a straightforward surgical technique, low rate of complications, minimal inpatient stay, the allowance of ambulation and weightbearing, minimal post-operative follow-up treatment, and need for reoperation [4,[11][12][13] . The individualized condition of the knee that a patient initially presents with, as well as specific aspects of pre-, intra-, and postoperative stages, have been studied in their relationship to the rate of success, as measured by different variations of the aforementioned criteria.…”

“…Following insertion, the two nails are then joined using one of a number of interlocking mechanisms, depending on the specific manufacturer and type of nail used [25] . The advantages of this procedure include minimization of leg length discrepancy, the ability to immediately bear weight on the leg despite severe bone loss, avoidance of pin-track infections, and the use of multiple interlocking screws, which may enhance the vertical and rotational stability of the knee and ultimately improve fusion rate [13,14,20,22,[26][27][28] . Carrying out a knee arthrodesis, using a modular nail, is not a demanding procedure and in one study, which analyzed the effects of a Wichita Fusion Nail (Stryker Orthopedics, Mahwah, New Jersey, USA) there were no differences in fusion rates between surgeons who were performing the surgery for the first time and those who were more experienced [29] .…”

Two-Stage Exchange Using a Short Intramedullary Nail for Treatment of Periprosthetic Knee Infections: A Technique Worth Questioning

“…Our findings demonstrated an overall treatment success rate of 74.2%, similar to the current literature regarding temporary arthrodesis. In a similar study by Röhner et al, 30 16 septic knee patients with type IIb or higher AORI bone defects were treated with AO fixator rods as a temporary spacer. The authors reported a treatment success rate of 75%, with no cases of spacer loosening or periprosthetic fracture.…”