Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2018 | Research article

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.

Authors: Giovanni Balato, Maria Rizzo, Tiziana Ascione, Francesco Smeraglia, Massimo Mariconda

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Abstract

Background

Knee arthrodesis with intramedullary (IM) nail or external fixator (EF) is the most reliable therapeutic option to achieve definitive infection control in patients with septic failure of total knee arthroplasty (TKA). The first aim of this study was to compare re-infection rates following knee arthrodesis for periprosthetic joint infection (PJI) with IM nail or EF. The second aim was to compare rates of radiographic union, complication, and re-operation as well as clinical outcomes.

Methods

A systematic search was performed in electronic databases for longitudinal studies of PJIs (minimum ten patients; minimum follow-up = 1 year) treated by knee arthrodesis with IM nail or EF. Studies were also required to report the rate of re-infection as an outcome measure. Eligible studies were meta-analyzed using random-effect models.

Results

The rate (95% confidence intervals) of re-infection was 10.6% (95% CI 7.3 to 14.0) in IM nail arthrodesis studies. The corresponding re-infection rate for EF was 5.4% (95% CI 1.7 to 9.1). This difference was significant (p = 0.009). The use of IM nail resulted in more advantages than EF for frequency of major complications and limb shortening. Other postoperative clinical and radiographic outcomes were similar for both surgical strategies.

Conclusions

The available evidence from the aggregate published data suggests that knee arthrodesis with EF in the specific context of PJI has a reduced risk of re-infection in comparison with the IM nail strategy. The use of IM nail is more effective for the complication rate and shortening of the affected limb.

Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD, INFORM Team. Re-infection outcomes following one- and two-stage surgical revision of infected knee prosthesis: a systematic review and meta-analysis. PLoS One. 2016;11:e0151537.CrossRefPubMedPubMedCentral

Gehrke T, Alijanipour P, Parvizi J. The management of an infected total knee arthroplasty. Bone Joint J. 2015;97-B(10 Suppl A):20–9.CrossRefPubMed

Ascione T, Pagliano P, Balato G, Mariconda M, Rotondo R, Esposito S. Oral therapy, microbiological findings, and comorbidity influence the outcome of prosthetic joint infections undergoing 2-stage exchange. J Arthroplast. 2017;32:2239–43.CrossRef

Schwarzkopf R, Oh D, Wright E, Estok DM, Katz JN. Treatment failure among infected periprosthetic patients at a highly specialized revision TKA referral practice. Open Orthop J. 2013;7:264–71.CrossRefPubMedPubMedCentral

Hawi N, Kendoff D, Citak M, Gehrke T, Haasper C. Septic single-stage knee arthrodesis after failed total knee arthroplasty using a cemented coupled nail. Bone Joint J. 2015;97-B:649–53.CrossRefPubMed

Chen AF, Kinback NC, Heyl AE, McClain EJ, Klatt BA. Betterfunction for fusions versus above-the-knee amputations for recurrent periprosthetic knee infection. Clin Orthop Relat Res. 2012;470:2737–45.CrossRefPubMedPubMedCentral

Conway JD, Mont MA, Bezwada HP. Arthrodesis of the knee. J Bone Joint Surg Am. 2004;86-A:835–48.CrossRefPubMed

Wu CH, Gray CF, Lee GC. Arthrodesis should be strongly considered after failed two-stage reimplantation TKA. Clin Orthop Relat Res. 2014;472:3295–304.CrossRefPubMedPubMedCentral

Mabry TM, Jacofsky DJ, Haidukewych GJ, Hanssen AD. Comparison of intramedullary nailing and external fixation knee arthrodesis for the infected knee replacement. Clin Orthop Relat Res. 2007;464:11–5.PubMed

10.

Iacono F, Raspugli GF, Bruni D, et al. Arthrodesis after infected revision TKA: retrospective comparison ofintramedullary nailing and external fixation. HSS J. 2013;9:229–35.CrossRefPubMed

11.

White CJ, Palmer AJR, Rodriguez-Merchan EC. External fixation vs intramedullary nailing for knee arthrodesis after failed infected total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty. 2017;33:1288-95.CrossRefPubMed

12.

Röhner E, Windisch C, Nuetzmann K, Rau M, Arnhold M, Matziolis G. Unsatisfactory outcome of arthrodesis performed after septic failure of revision total knee arthroplasty. J Bone Joint Surg Am. 2015;97-A:298–301.CrossRef

13.

Balci HI, Saglam Y, Pehlivanoglu T, Sen C, Eralp L, Kocaoglu M. Knee arthrodesis in persistently infected total knee arthroplasty. J Knee Surg. 2016;29:580–8.CrossRefPubMed

14.

Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647.CrossRefPubMed

15.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73:712–6.CrossRefPubMed

16.

Bargiotas K, Wohlrab D, Sewecke JJ, Lavinge G, Demeo PJ, Sotereanos NG. Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. J Bone Joint Surg Am. 2006;88:553–8.PubMed

17.

Barton TM, White SP, Mintowt-Czyz W, Porteous AJ, Newman JH. A comparison of patient based outcome following knee arthrodesis for failed total knee arthroplasty and revision knee arthroplasty. Knee. 2008;15:98–100.CrossRefPubMed

18.

Corona PS, Hernandez A, Reverte-Vinaixa MM, Amat C, Flores X. Outcome after knee arthrodesis for failed septic total knee replacement using a monolateral external fixator. J Orthop Surg (Hong Kong). 2013;21:275–80.CrossRef

19.

Crockarell JR Jr, Mihalko MJ. Knee arthrodesis using an intramedullary nail. J Arthroplast. 2005;20:703–8.CrossRef

20.

David R, Shtarker H, Horesh Z, Tsur A, Soudry M. Arthrodesis with the Ilizarov device after failed knee arthroplasty. Orthopedics. 2001;24:33–6.PubMed

21.

De Cloedt P, Emery R, Legaye J, Lokietek W. Infected total knee prosthesis. Guidance for therapeutic choice. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:626–33.PubMed

22.

Domingo LJ, Caballero MJ,·Cuenca J, Herrera A,·Sola A, Herrero L. Knee arthrodesis with the Wichita fusion nail. Int Orthop 2004;28:25–27.CrossRefPubMed

23.

Friedrich MJ, Schmolders J, Wimmer MD, et al. Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency. Knee. 2017;24:1240-46.CrossRefPubMed

24.

Gore DR, Gassner K. Use of an intramedullary rod in knee arthrodesis following failed total knee arthroplasty. J Knee Surg. 2003;16:165–7.PubMed

25.

Hak DJ, Lieberman JR, Finerman GA. Single plane and biplane external fixators for knee arthrodesis. Clin Orthop Relat Res. 1995;316:134–44.

26.

Hungerer S, Kiechle M, von Rüden C, Militz M, Beitzel K, Morgenstern M. Knee arthrodesis versus above-the-knee amputation after septic failure of revision total knee arthroplasty: comparison of functional outcome and complication rates. BMC Musculoskelet Disord. 2017;18:443.CrossRefPubMedPubMedCentral

27.

Klinger HM, Spahn G, Schultz W, Baums MH. Arthrodesis of the knee after failed infected total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2006;14:447–53.CrossRefPubMed

28.

Lai KA, Shen WJ, Yang CY. Arthrodesis with a short Huckstep nail as a salvage procedure for failed total knee arthroplasty. J Bone Joint Surg Am. 1998;80-A:380–8.CrossRef

29.

Miralles-Muñoz FA, Lizaur-Utrilla A, Manrique-Lipa C, López-Prats FA. Arthrodesis without bone fusion with an intramedullary modular nail for revision of infected total knee arthroplasty. Rev Esp Cir Ortop Traumatol. 2014;58:217–22.PubMed

30.

Parratte S, Madougou S, Villaba M, Stein A, Rochwerger A, Curvale G. Knee arthrodesis with a double mono-bar external fixators to salvage infected knee arthroplasty: retrospective analysis of 18 knees with mean seven-year follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:373–80.CrossRefPubMed

31.

Putman S, Kern G, Senneville E, Beltrand E, Migaud H. Knee arthrodesis using customised modular intramedullary nail in failed infected total knee arthroplasty. Orthop Traumatol Surg Res. 2013;99:391–8.CrossRefPubMed

32.

Reddy VG, Kumar RV, Mootha AK, Thayi C, Kantesaria P, Reddy D. Salvage of infected total knee arthroplasty with Ilizarov external fixator. Indian J Orthop. 2011;45:541–7.CrossRefPubMedPubMedCentral

33.

Scarponi S, Drago L, Romanò D, et al. Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results. Int Orthop. 2014;38:413–8.CrossRefPubMed

34.

Talmo CT, Bono JV, Figgie MP, Sculco TP, Laskin RS, Windsor RE. Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR. HSS J. 2007;3:83–8.CrossRefPubMedPubMedCentral

35.

Volpi R, Dehoux E, Touchard P, Mensa C, Segal P. Knee arthrodesis using a customized intramedullary nail: 14 cases. Rev Chir Orthop Reparatrice Appar Mot. 2004;90:58–64.CrossRefPubMed

36.

Waldman BJ, Mont MA, Payman KR, et al. Infected total knee arthroplasty treated with arthrodesis using a modular nail. Clin Orthop Relat Res. 1999;367:230–7.CrossRef

37.

Wilde AH, Stearns KL. Intramedullary fixation for arthrodesis of the knee after infected total knee arthroplasty. Clin Orthop Relat Res. 1989;248:87–92.

38.

Damron TA, McBeath AA. Arthrodesis following failed total knee arthroplasty: comprehensive review and meta-analysis of recent literature. Orthopedics. 1995;18:361–8.PubMed

39.

Gurney B, Mermier C, Robergs R, Gibson A, Rivero D. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am. 2001;83-A:907–15.CrossRefPubMed

40.

Wilding CP, Cooper GA, Freeman AK, Parry MC, Jeys L. Can a silver-coated arthrodesis implant provide a viable alternative to above knee amputation in the unsalvageable, infected total knee arthroplasty? J Arthroplast. 2016;31:2542–7.CrossRef

41.

Ramazzini-Castro R, Pons-Cabrafiga M. Knee arthrodesis in rescue surgery: a study of 18 cases. Rev Esp Cir Ortop Traumatol. 2013;57:45–52.PubMed

Title: Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.
Authors: Giovanni Balato
Maria Rizzo
Tiziana Ascione
Francesco Smeraglia
Massimo Mariconda
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-018-2283-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Biologic plating of unstable distal radial fractures

The prevalence and under-diagnosis of vertebral fractures on chest radiograph

Arthroscopic debridement of anterior ankle impingement in patients with chronic lateral ankle instability

The knitting community-based trial for older women with osteoarthritis of the hands: design and rationale of a randomized controlled trial

Distribution of ossified spinal lesions in patients with severe ossification of the posterior longitudinal ligament and prediction of ossification at each segment based on the cervical OP index classification: a multicenter study (JOSL CT study)

The change of first metatarsal head articular surface position after Lapidus arthrodesis