Comparative Analysis of Knee Joint Fusion with Long Locking Nail and Ilizarov Apparatus in Patients with Deep Infection after Arthroplasty

Cover Page


Cite item

Abstract

Relevance. Deep infection after knee arthroplasty requires radical surgical treatment of the infection site, removal of endoprosthesis components, and an antimicrobial spacer placement. If revision knee arthroplasty is impossible, the «gold standard» for this kind of patients is knee joint arthrodesis. The purpose of the study was the comparative analysis of knee joint fusion by external and internal fixation. Materials and Methods. The analysis of 60 cases of knee arthrodesis was carried out. The patients were divided into two groups with 30 patients in each. In the first group, knee arthrodesis was performed with long locking nail, in the second group — with external ring fixation. We compared the groups by intraoperative and drainage blood loss, the inpatient treatment duration, the terms of fusion and complications registered. The patients quality of life was evaluated using the SF-36 questionnaire before surgery, for the periods of 3, 6, and 12 months after the surgery. Results. The comparison of two methods of knee arthrodesis showed that blood loss in the internal fixation compared with external one, was 2.03 times more, the duration of inpatient treatment was 1.4 times less, and the total number of complications was 4.4 times less. However, the complications that affected the treatment outcome in long nail group were 1.5 times more. The differences in the average time of ankylosis formation were not statistically significant (p<0.05). The functional results of the treatment in 3 months after surgery in the group with internal fixation were much better. In 6 months after surgery the quality of life had no significant differences. In 12 months follow-up the indices in both groups were the same. Conclusion. The results of our study suggests us to think, knee joint arthrodesis by long fusion nail should be prefereble. If the nail insertion is technically impossible, and there is the high risk of deep infection recurrence, the external osteosynthesis should be used.

About the authors

L. N. Solomin

Vreden National Medical Research Center of Traumatology and Orthopedics; St. Petersburg State University

Email: fake@neicon.ru
ORCID iD: 0000-0003-3705-3280

Leonid N. Solomin – Dr. Sci. (Med.), Professor, Leading Researcher, Vreden National Medical Research Center of Traumatology and Orthopedics; Professor of the Surgery Chair Medical Faculty, St. Petersburg State University

St. Petersburg

Russian Federation

E. A. Shchepkina

Vreden National Medical Research Center of Traumatology and Orthopedics; Pavlov First St. Petersburg State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0001-6132-0305

Elena A. Shchepkina — Cand. Sci. (Med.), Senior Researcher, Vreden National Medical Research Center of Traumatology and Orthopedics; Associate Professor, Department of Traumatology and Orthopedics, Pavlov First St. Petersburg State Medical University

St. Petersburg

Russian Federation

K. L. Korchagin

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: korchagin.konstantin@gmail.com
ORCID iD: 0000-0001-8354-1950

Konstantin L. Korchagin — Cand. Sci. (Med.), Researcher Assistant

St. Petersburg

Russian Federation

F. K. Sabirov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru
ORCID iD: 0000-0002-0307-0771

Fanil K. Sabirov — Cand. Sci. (Med.), Associate Professor, Department of Traumatology and Orthopedics

St. Petersburg,

Russian Federation

References

  1. Ермаков А.М., Клюшин Н.М., Абабков Ю.В., Тряпичников А.С., Коюшков А.Н. Оценка эффективности двухэтапного хирургического лечения больных с перипротезной инфекцией коленного и тазобедренного суставов. Гений ортопедии. 2018;24(3):321-326. doi: 10.18019/1028-4427-2018-24-3-321-326.
  2. Iorio R., Robb W.J., Healy W.L., Berry D.J., Hozack W.J., Kyle R.F. et al. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90(7):1598-1605. doi: 10.2106/JBJS.H.00067.
  3. Oostenbroek H., van Roermund P. Arthrodesis of the knee after an infected arthroplasty using the Ilizarov method. J Bone Joint Surg Br. 2001;83(1):50-54. doi: 10.1302/0301-620x.83b1.10572.
  4. Корнилов Н.Н., Куляба Т.А., Филь А.С., Муравьёва Ю.В. Данные регистра эндопротезирования коленного сустава РНИИТО им. Р.Р. Вредена за 2011–2013 годы. Травматология и ортопедия России. 2015;(1):136-151. doi: 10.21823/2311-2905-2015-0-1-136-151.
  5. Преображенский П.М., Божкова С.А., Каземирский А.В., гончаров М.Ю. Результаты этапного лечения пациентов с перипротезной инфекцией после эндопротезирования коленного сустава. Травматология и ортопедия России. 2017;23(1):98-107. doi: 10.21823/2311-2905-2017-23-1-98-107.
  6. Conway J.D., Mont M.A., Bezwada H.P. Arthrodesis of the knee. J Bone Joint Surg Am. 2004;86(4):835-848. doi: 10.2106/00004623-200404000-00027.
  7. Kuchinad R., Fourman M.S., Fragomen A.T., Rozbruch R.S. Knee arthrodesis as limb salvage for complex failures of total knee arthroplasty. J Arthroplasty. 2014;29(11): 2150-2155. doi: 10.1016/j.arth.2014.06.021.
  8. Соломин Л.Н., Корчагин К.Л., Розбрух Р.С. Классификация дефектов костей, образующих коленный сустав, у пациентов с противопоказаниями к эндопротезированию. Травматология и ортопедия России. 2018;24(1):36-43. doi: 10.21823/2311-2905-2018-24-1-36-43.
  9. Caton J. Traitement des inégalités de longueur des membres inférieurs et des sujets de petite taille chez l’enfant et l’adolescent. Rev Chir Orthop. 1991;77 (Suppl. I):31-80.
  10. Balci H., Saglam y., Pehlivanoglu T., Sen C., Eralp L., Kocaoglu M. Knee arthrodesis in persistently infected total knee arthroplasty. J Knee Surg. 2015;29(07):580-588. doi: 10.1055/s-0035-1569479.
  11. Incavo S.J., Lilly J.W., Bartlett C.S., Churchill D.L. Arthrodesis of the knee: experience with intramedullary nailing. J Arthroplasty. 2000;15(7):871-876. doi: 10.1054/arth.2000.9060.
  12. Gallusser N., Goetti P., Luyet A., Borens O. Knee arthrodesis with modular nail after failed TKA due to infection. Eur J Orthop Surg Traumatol. 2015;25(8):13071312. doi: 10.1007/s00590-015-1707-1.
  13. Bruno A., Kirienko A., Peccati A., Dupplicato P., De Donato M., Arnaldi E., Portinaro N. Knee arthrodesis by the Ilizarov method in the treatment of total knee arthroplasty failure. The Knee. 2017;24(1):91-99. doi: 10.1016/j.knee.2016.11.002.
  14. Leroux B., Aparicio G., Fontanin N., Ohl x., Madi K., Dehoux E. et al. Arthrodesis in septic knees using a long intramedullary nail: 17 consecutive cases. Orthop Traumatol Surg Res. 2013;99(4):399-404. doi: 10.1016/j.otsr.2013.03.011.
  15. Клюшин Н.М., Абабков Ю.В., Бурнашов С.И., Ермаков А.М. Результат артропластики коленного сустава после септического артрита методом билокального компрессионно-дистракционного остеосинтеза по Илизарову с костной пластикой надколенником (случай из практики). Гений ортопедии. 2014;(4):89-92.
  16. Клюшин Н.М., Шляхов В.И., Чакушиш Б.Э., Злобин А.В., Бурнашов С.И., Абабков Ю.В. и др. Чрескостный остеосинтез в лечении больных хроническим остеомиелитом после эндопротезирования крупных суставов. Гений Ортопедии. 2010;(2): 37-43.
  17. Garberina M.J., Fitch R.D., Hoffmann E.D., Hardaker W.T., Vail T.P., Scully S.P. Knee arthrodesis with circular external fixation. Clin Orthop Relat Res. 2001;(382):168-178. doi: 10.1097/00003086-200101000-00023.
  18. Klinger H.M., Spahn G., Schultz W., Baums M.H. Arthrodesis of the knee after failed infected total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2005;14(5):447-453. doi: 10.1007/s00167-005-0664-3.
  19. Chen A.F., Kinback N.C., Heyl A.E., McClain E.J., Klatt B.A. Better function for fusions versus above-theknee amputations for recurrent periprosthetic knee infection. Clin Orthop Relat Res. 2012;470(10):27372745. doi: 10.1007/s11999-012-2322-7.
  20. Corona P.S., Hernandez A., Reverte-Vinaixa M.M., Amat C., Flores x. Outcome after knee arthrodesis for failed septic total knee replacement using a monolateral external fixator. J Orthop Surg. 2013;21(3):275-280. doi: 10.1177/230949901302100302.
  21. Parvizi J., Rothman R.H., Wiesel S.W. (ed.). Operative Techniques in Adult Reconstruction Surgery. Philadelphia : Lippincott Williams & Wilkins; 2011.336 p.
  22. Wood J.H., Conway J.D. Advanced concepts in knee arthrodesis. World J Orthop. 2015;6(2):202-210. doi: 10.5312/wjo.v6.i2.202.

Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies