Skip to main content
SpringerLink
Log in

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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The present study describes a new temporary arthrodesis procedure, which aims for septic knee prosthesis replacement, in particular for larger bone and soft tissue defects. Our technique offers high stability and full weight-bearing capacity of the knee joint.

Methods

The study included 16 patients with major bone defects (AORI type IIb or greater) after receiving a radical debridement and a septic two-stage revision total knee arthroplasty. After removing the infected prosthesis and debridement, two AO fixator rods were positioned into the intramedullary space of the femur and tibia. Subsequently, both rods were joined tube-to-tube and adjusted in the center of the knee joint. Finally, the whole cavity of the knee joint was filled with PMMA. The number of previous surgeries, bacterial spectrum, risk factors for further infection and reinfection rates was recorded. Immediately after the temporary arthrodesis, radiographs of the knee with the enclosed spacers were taken in order to compare to previous radiographs and avoiding to miss possible spacer loosening.

Results

Nine of sixteen patients underwent more than two revision surgeries before receiving our new arthrodesis technique. No cases of spacer loosening were observed in all 16 patients; further, there were no peri-implant fractures, and four persistent infections were noted.

Conclusions

Temporary arthrodesis using AO fixator rods offers a high stability without loosening. Its potential to replace conventional augmentation techniques should be taken into account, particularly in the case of larger bone and tissue defects. In clinical practice, the cemented spacer using AO fixator rods could be an alternative technique for temporary knee arthrodesis after septic debridement.

Level of evidence

Retrospective case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Antoci V, Phillips MJ, Antoci V Jr, Krackow KA (2009) The treatment of recurrent chronic infected knee arthroplasty with a 2-stage procedure. J Arthroplast 24–1(159):e13–e17

    Google Scholar 

  2. Baker P, Petheram TG, Kurtz S, Konttinen YT, Gregg P, Deehan D (2013) Patient reported outcome measures after revision of the infected TKR: comparison of single versus two-stage revision. Knee Surg Sports Traumatol Arthrosc 21(12):2713–2720

    Article  PubMed  Google Scholar 

  3. Burnett RS, Kelly MA, Hanssen AD, Barrack RL (2007) Technique and timing of two-stage exchange for infection in TKA. Clin Orthop Relat Res 64:164–178

    Google Scholar 

  4. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Jt Surg Am 89–4:871–882

    Article  Google Scholar 

  5. Durbhakula SM, Czajka J, Fuchs MD, Uhl RL (2004) Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty. J Arthroplast 19–6:768–774

    Article  Google Scholar 

  6. Emerson RH Jr, Muncie M, Tarbox TR, Higgins LL (2002) Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 404:132–138

    Article  PubMed  Google Scholar 

  7. Engh GA, Ammeen DJ (1999) Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect 48:167–175

    PubMed  CAS  Google Scholar 

  8. Fehring TK, Odum S, Calton TF, Mason JB (2000) Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res 380:9–16

    Article  PubMed  Google Scholar 

  9. Fitzgerald SJ, Hanssen AD (2011) Surgical techniques for staged revision of the chronically infected total knee arthroplasty. Surg Technol Int XXI:204–211

    Google Scholar 

  10. Freeman MG, Fehring TK, Odum SM, Fehring K, Griffin WL, Mason JB (2007) Functional advantage of articulating versus static spacers in 2-stage revision for total knee arthroplasty infection. J Arthroplast 22–8:1116–1121

    Article  Google Scholar 

  11. Gooding CR, Masri BA, Duncan CP, Greidanus NV, Garbuz DS (2011) Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res 469–4:985–993

    Article  Google Scholar 

  12. Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Jt Surg Br 82–6:807–812

    Article  Google Scholar 

  13. Haleem AA, Berry DJ, Hanssen AD (2004) Mid-term to long-term follow up of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res 428:35–39

    Article  PubMed  Google Scholar 

  14. Hirakawa K, Stulberg BN, Wilde AH, Bauer TW, Secic M (1998) Results of 2-stage reimplantation for infected total knee arthroplasty. J Arthroplast 13–1:22–28

    Article  Google Scholar 

  15. Hofmann AA, Goldberg T, Tanner AM, Kurtin SM (2005) Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res 430:125–131

    Article  PubMed  Google Scholar 

  16. Insall JN, Thompson FM, Brause BD (1983) Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Jt Surg Am 65–8:1087–1098

    Google Scholar 

  17. Jamsen E, Stogiannidis I, Malmivaara A, Pajamaki J, Puolakka T, Konttinen YT (2009) Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop 80–1:67–77

    Article  Google Scholar 

  18. Kubista B, Hartzler RU, Wood CM, Osmon DR, Hanssen AD, Lewallen DG (2012) Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop 36–1:65–71

    Article  Google Scholar 

  19. Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D (2014) Two-stage Revision Arthroplasty for Management of Chronic Periprosthetic Hip and Knee Infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg 22(3):153–164

    Article  PubMed  Google Scholar 

  20. Lombardi AV Jr, Karnes JM, Berend KR (2007) A motion maintaining antibiotic delivery system. J Arthroplast 22–4(Suppl 1):50–55

    Article  Google Scholar 

  21. Mittal Y, Fehring TK, Hanssen A, Marculescu C, Odum SM, Osmon D (2007) Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Jt Surg Am 89–6:1227–1231

    Google Scholar 

  22. Nickinson RS, Board TN, Gambhir AK, Porter ML, Kay PR (2012) Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability. Knee 191:24–27

    Article  Google Scholar 

  23. Oduwole KO, Molony DC, Walls RJ, Bashir SP, Mulhall KJ (2010) Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 18:945–948

    Article  PubMed  Google Scholar 

  24. Pascale V, Pascale W (2007) Custom-made articulating spacer in two-stage revision total knee arthroplasty. An early follow-up of 14 cases of at least 1 year after surgery. HSS J 3–2:159–163

    Article  Google Scholar 

  25. Romano CL, Gala L, Logoluso N, Romano D, Drago L (2012) Two- stage revision of septic knee prothesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc 20:2445–2453

    Article  PubMed  CAS  Google Scholar 

  26. Van Rensch PJ, Van de Pol GJ, Goosen JH, Wymenga AB, De Man FH (2014) Arthrodesis of the knee following failed arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:1940–1948

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Traumatology and Orthopaedics, Charité University Hospital, Berlin, Germany

    Eric Röhner, Tilman Pfitzner, Bernd Preininger, Timo Zippelius & Carsten Perka

  2. Department of Orthopaedics, Rudolf-Elle-Hospital, Friedrich-Schiller-University, Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany

    Eric Röhner

Authors
  1. Eric Röhner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tilman Pfitzner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernd Preininger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timo Zippelius
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carsten Perka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric Röhner.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Röhner, E., Pfitzner, T., Preininger, B. et al. Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects. Knee Surg Sports Traumatol Arthrosc 24, 84–88 (2016). https://doi.org/10.1007/s00167-014-3324-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3324-7

Keywords

Search

Navigation