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Uniplanar versus biplanar monolateral external fixator knee arthrodesis after end-stage failed infected total knee arthroplasty: a comparative study

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A Correction to this article was published on 17 August 2021

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Abstract

Background

External fixator knee arthrodesis is a salvage procedure used primarily in cases of end-stage infected total knee replacement (iTKR). Stable fixation combined with bone-end compression is essential to achieve knee fusion, but providing sufficient stability can be challenging in the presence of severe bone loss. Our hypothesis is that using an external fixation biplanar configuration would bring about a fusion rate superior to that of a monolateral frame.

Methods

This study compares outcomes of biplanar external fixator knee fusion due to non-revisable iTKR with those of a historical cohort control study with patients managed with a monoplanar configuration. Primary endpoints were fusion rate, time to achieve bone fusion and infection eradication rate. Limb-length discrepancy, pain level, patient satisfaction and health-related quality of life were evaluated.

Results

A total of 29 knee fusion cases were included. In the biplanar group, infection was eradicated in 100% of the patients and fusion was achieved in all cases within an average of 5.24 months. In comparison, in the monolateral group, infection was eradicated in 86% of the cases and fusion was achieved in 81% of the patients after a mean of 10.3 months (p < 0.05). In both groups, postoperative pain was mild and patients expressed a high degree of satisfaction once fusion was achieved.

Conclusions

According to our data, external fixation knee fusion is a useful limb-salvage procedure in end-stage cases of knee PJI. We conclude that a biplanar configuration can halve the time required to achieve solid bone fusion in such a complex scenario.

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Acknowledgements

We wish to thank Russell Williams of RoundlyWorded.com for his editorial recommendations. We further wish to thank our entire multidisciplinary team, including Dr. Carles Amat, member of the Septic and Reconstructive Surgery Unit; Dr. Jordi Serracanta and Dr. Jordi Aguilera, members of the Plastic Surgery Department, and Dr. Juan Carlos Juarez, a member of our center’s Pharmacy Department. I would also like to acknowledge the inestimable help of our infectious diseases team, with Dr. Carles Pigrau and Dr. Dolors Rodrigez-Pardo, as well our microbiology specialist, Dr. Mayli Lung. Without her help, it would be far more difficult to operate on patients of this type. Finally, we want to acknowledge the help and methodological support offered by the MBA Institute in the realization of this study.

Funding

This work received no outside financial support. The study was conducted as part of the routine work of our institution.

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Author notes

  1. Pablo S. Corona and Maria Jurado have contributed equally in producing this paper.

Authors and Affiliations

  1. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall D’Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Pablo S. Corona, Maria Jurado, Luis Carrera & Matías Vicente

  2. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall D’Hebron University, Barcelona, Spain

    Pablo S. Corona, Rosa Fraile, Luis Carrera & Matías Vicente

  3. Orthopaedic Surgery Department, Arnau de Vilanova University Hospital, Lleida, Spain

    Ana Scott-Tennent

  4. Surgical Nurse Team, Vall D’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

    Rosa Fraile

  5. Musculoskeletal Tissue Engineering Group, Vall D’Hebron Research Institute, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain

    Pablo S. Corona, Maria Jurado, Luis Carrera & Matías Vicente

Authors
  1. Pablo S. Corona
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Corresponding author

Correspondence to Matías Vicente.

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Conflict of interest

Pablo S. Corona declares that he has no conflict of interest. Maria Jurado declares that she has no conflict of interest. Ana Scott-Tennent declares that she has no conflict of interest. Rosa Fraile declares that she has no conflict of interest. Luis Carrera declares that he has no conflict of interest. Matías Vicente declares that he has no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by our center’s Ethics Committee (CEIC).

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Informed consent was obtained from all individual participants included in the study.

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Corona, P.S., Jurado, M., Scott-Tennent, A. et al. Uniplanar versus biplanar monolateral external fixator knee arthrodesis after end-stage failed infected total knee arthroplasty: a comparative study. Eur J Orthop Surg Traumatol 30, 815–825 (2020). https://doi.org/10.1007/s00590-020-02633-2

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  • DOI: https://doi.org/10.1007/s00590-020-02633-2

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