Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency

Friedrich, M; Schmolders, Jan; Wimmer, Matthias; Strauß, Andreas C.; Plöeger, Milena M.; Wirtz, Dieter Christian; Gravius, Sascha; Randau, Thomas M.

doi:10.1016/j.knee.2017.05.019

Cited by 28 publications

(34 citation statements)

References 46 publications

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“…Knee Score range 38-39.2 and WOMAC score was 55.8 [20][21][22]. The functional outcomes and subjective measurements of pain in our patient group are comparable to these results.…”

Section: Discussionsupporting

confidence: 82%

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Straight versus modular nail: Analysis of mechanical properties two knee arthrodesis methods.

Białecki¹,

Para²,

Sobolewski³

et al. 2020

Preprint

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Background Complications after arthroplasty often result in irreversible disability. In some cases for the extremity to be salvaged, the permanent knee joint arthrodesis is the last-chance procedure. Modular implant design simplifies surgical technique but modularity may potentially compromise mechanical strength of an implant. Mechanical properties of the implant are particularly important in case of knee arthrodesis without bone-on-bone contact where forces during gait and weight bearing are transmitted directly through the nail. The aim of this article was to perform comparative analysis of the mechanical properties of modular nail CHARFIX2 FN, when compared to the femoral nail, used for knee arthrodesis; and to analyze the effectiveness of treatment with use of this nail based on the observations of clinical cases. Methods Comparative analysis of: the static 4-point bending test, dynamic 4-point bending test and static torsion test. All tests were performed in accordance with requirements of ASTM F 1264. A clinical analysis of 5 cases, in which CHARFIX2 FN nails were used, was also performed. Results Based on the results of mechanical tests, the strength characteristics of CHARFIX2 FN nail have been found superior and more advantageous than corresponding features of the standard femoral nail. For CHARFIX2 FN nail, the median for flexural stiffness was almost 4 times higher and for maximum torque value was almost 2 times higher when compared to the femoral nail. Observations of the clinical cases gave satisfactory results. Conclusions The obtained mechanical tests present significant differences between CHARFIX2 FN and the femoral nail in mechanical strength and, therefore, its improved stability and safety for patients during walking. It can be used for permanent knee immobilization with satisfactory clinical results. The functional outcomes and subjective measurements of pain in patients treated with CHARFIX2 FN group are satisfying.

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“…Knee Score range 38-39.2 and WOMAC score was 55.8 [20][21][22]. The functional outcomes and subjective measurements of pain in our patient group are comparable to these results.…”

Section: Discussionsupporting

confidence: 82%

“…reconstruction in cases with severe bone loss, reducing loads acting directly on the nail [10]. On the other hand, modularity may potentially compromise mechanical strength of an implant.…”

mentioning

confidence: 99%

Straight versus modular nail: Analysis of mechanical properties two knee arthrodesis methods.

Białecki¹,

Para²,

Sobolewski³

et al. 2020

Preprint

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“…20,21 The management of PJI in the PT is extremely challenging due to the poor soft tissue coverage and impaired extensor mechanism often encountered, making limb salvage difficult. Modular KA prostheses have gained popularity in the arthroplasty community as an alternative to amputation for treatment of the multiply revised, infected total knee replacement (TKR), [22][23][24] particularly for cases where there is a deficient extensor mechanism and poor soft tissue coverage. The main goal of KA is to gain a stable, pain-free lower limb with a low risk of reinfection and an acceptable functional outcome.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Knee fusion can be achieved either using a one-or twostage procedure [16]. In the presence of chronic infection, some authors have demonstrated good results using a onestage process to achieve knee fusion; however, caution is advised in patients who have had multiple previous attempts at revision, comorbidities, and infections with resistant organisms [17].…”

Section: Case Reports In Orthopedicsmentioning

confidence: 99%

“…In the infected case, it is recommended that the procedure be done in two stages, using preoperative aspiration, CRP, and ESR tests to confirm eradication of the infection before definitive fusion [3,4,16,[18][19][20]. Bargiotas et al demonstrated that when a two-stage technique was used, and there was biochemical evidence that the infection was eradicated, excellent results could be attained [21].…”

Section: Case Reports In Orthopedicsmentioning

confidence: 99%

Two-Stage Arthrodesis after an Infected Total Knee Replacement Using a Coupled Nail and Dual-Plate Construct: A Third-World Solution and Review of Options

Mencia

Goalan

Bua

2020

Case Reports in Orthopedics

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Infection following total knee arthroplasty is a serious and increasingly common complication. Several treatment options are available. Although a two-stage revision remains the gold standard, salvage procedures are sometimes needed. We describe a case of an infected knee arthroplasty that was salvaged using a novel technique combining two linked intramedullary nails and bilateral compression plating.

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Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency

Cited by 28 publications

References 46 publications

Straight versus modular nail: Analysis of mechanical properties two knee arthrodesis methods.

Straight versus modular nail: Analysis of mechanical properties two knee arthrodesis methods.

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

Two-Stage Arthrodesis after an Infected Total Knee Replacement Using a Coupled Nail and Dual-Plate Construct: A Third-World Solution and Review of Options

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