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Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator—a series of one hundred fifty two patients

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Abstract

Purpose

Arthrodesis of the knee joint is still a salvage procedure after recurrent prosthetic joint infections (PJI) of total knee arthroplasties (TKA) with substantial bone loss and seems to be a good solution to avoid amputation. Until now, intramedullary arthrodesis has increasingly been performed; no study has yet been published to compare these techniques after septic removal of TKA in terms of functional assessment and quality of daily life.

Methods

In a single-centre retrospective setting, clinical and radiographic evaluation of consecutive patients after knee arthrodesis using intramedullary and external fixation for infected knee joints was performed. All patients were evaluated clinically, with x-ray and questionnaire including analysis regarding any complications at latest follow-up of a minimum 12 months postoperatively.

Results

We included 152 patients (75 females, 77 males) in this study. The mean age of the patients at surgery was 63.6 years (range 12 to 90 years). The minimum follow-up was 12 months (mean 3.1 years, range 12 to 49 months). Arthrodesis with external fixator (83 patients, 52.2%) showed less blood loss and less peri-operative complications (1.6%) but a high rate of post-operative, pin-track infections (35.5%); loose pins (12.7%); and pin fractures (4.8%), and therefore risk factors for instability and nonunion (30.9%). Revision rate was 22.6% for arthrodesis with external fixator, and the primary union rate was 65.6%. Intramedullary arthrodesis (69 patients, 43.4%) showed a similar re-infection rate to external fixation (16.1% and 15.9%, respectively) but a significantly lower revision rate (5.4%, p < 0.001). Eighty percent of patients with intramedullary arthrodesis showed very good patient-related outcomes regarding pain, function and daily life activities in the questionnaire.

Conclusion

Despite similar results regarding patient satisfaction and everyday competences in questionnaires, intramedullary arthrodesis of the knee is superior to the external fixator, as it results in fewer complications, lower revision rate, and union rates/loosening.

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Data availability

The availability of data and material is with the corresponding author due to ethical committee vote.

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Authors and Affiliations

  1. AUVA Trauma Center Salzburg, Department of Orthopaedics and Trauma Surgery, Academic Teaching Hospital of Paracelsus Medical University, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria

    Arnold J. Suda

  2. BG Trauma Center Ludwigshafen, Department of Trauma and Orthopaedics, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany

    Xaver Brachtendorf & Oliver E. Bischel

  3. Sinsheim Hospital, Department of Orthopaedics and Trauma Surgery, Sinsheim, Germany

    Marco Tinelli

  4. Jordanian Royal Medical Services, Department of Orthopaedics, Amman, Jordan

    Raed Wagokh & Ghaith Abou-Nouar

Authors
  1. Arnold J. Suda
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  2. Xaver Brachtendorf
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  3. Marco Tinelli
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  4. Raed Wagokh
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  5. Ghaith Abou-Nouar
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  6. Oliver E. Bischel
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Xaver Brachtendorf and Arnold J Suda. The first draft of the manuscript was written by Arnold J Suda, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Conceptualization: Arnold J. Suda, Oliver Bischel, Marco Tinelli; methodology: Arnold J. Suda, Oliver Bischel, Marco Tinelli; formal analysis and investigation: Xaver Brachtendorf, Arnold J. Suda; writing—original draft preparation: Arnold J. Suda; writing—review and editing: Arnold J. Suda, Raed Wagkoh, Ghaith Abou-Nouar; resources: Arnold J. Suda; supervision: Arnold J. Suda, Oliver E Bischel.

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Correspondence to Arnold J. Suda.

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The study was approved by the regional and institutional ethical committee, and the authors certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Level of evidence: III—retrospective cohort.

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Suda, A.J., Brachtendorf, X., Tinelli, M. et al. Low complication rate and better results for intramedullary nail - arthrodesis for infected knee joints compared to external fixator—a series of one hundred fifty two patients. International Orthopaedics (SICOT) 45, 1735–1744 (2021). https://doi.org/10.1007/s00264-021-05054-w

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