Knee arthrodesis as a salvage procedure for infected total arthroplasty and chronic septic conditions of a knee joint using Ilizarov | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 47, Issue 4, December 2012, Pages 409-417 PDF (426.8 K) | ||
| Authors | ||
| Mohamed N. ElSayed; Ahmed M. ElBadrawi; Shady ElBeshry | ||
| Abstract | ||
| Background Knee arthrodesis has been performed since the early 1900s for a variety of indications. Ilizarov principles of hybrid fixation have enabled surgeons to achieve independent ambulation in all patients and resulted in fusion in most patients available for follow-up evaluation. Numerous treatments have been proposed for infected total knee arthroplasty. In selected patients, a knee arthrodesis is a well-known salvage procedure. This article reviews an experience with this technique in infected total knee arthroplasty and chronic septic knee conditions not a candidate for arthroplasty. Patients and methods Eleven patients (four men and seven women) were treated between January 2007 and December 2009 by arthrodesis using the Ilizarov apparatus. Nine patients with an active infection underwent a two-stage procedure (debridement, followed by arthrodesis). The remaining two patients had no evidence of active infection (acute-phase reactants were within normal limits and/or no discharging sinus) and underwent one-stage arthrodesis. The mean age of the patients was 58.1 years (range 41-75 years). From the time of frame removal, the patients were followed up for a mean of 21.4 months (range 10-39 months). Partial weight bearing was allowed 1 week after surgery. All patients achieved a stable knee arthrodesis after a mean duration of 5.2 months without additional surgical procedures or bracing. Results Fusion was achieved in all the patients. There were no recurrent infections. All patients could walk without walking aids. At the end of the follow-up period, limb shortening was evaluated and ranged from 1 to 2.5 cm (mean 1.3 cm). Pin-tract infections were found in all cases, all of which were successfully treated with oral antibiotics and local wound care. Pain was analyzed preoperatively and postoperatively using visual analouge scale, with a mean flexion of 7.81 (range 0-121) and a mean valgus of 7.11 (range 4-121). No persistent infection was found clinically at the end of the follow-up period. No implant failure occurred in any of the cases. Conclusion Knee arthrodesis by the Ilizarov method for infected knee conditions is a very useful method, particularly in patients with extensive bone loss, significant axial deformity or both, chronic septic conditions (multiple debridements, muscle atrophy, multiple healed sinuses, bone loss, critical skin conditions and disfigurement), or previous failed infected arthroplasty. Keywords: Ilizarov arthrodesis, infected knee, salvage procedure | ||
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