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.
BG Trauma Center Ludwigshafen, Department of Trauma and Orthopaedics, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
Int Orthop. 2021 Jul;45(7):1735-1744. doi: 10.1007/s00264-021-05054-w. Epub 2021 Apr 23.
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.
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.
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.
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.
膝关节融合术仍然是全膝关节置换术后复发性假体关节感染（PJI）且骨质大量丢失的一种挽救性手术，似乎是避免截肢的好方法。到目前为止，髓内融合术的应用越来越多；但尚无研究比较在 TKA 感染清除术后，采用髓内和外固定治疗感染性膝关节的这些技术在功能评估和日常生活质量方面的差异。
在单中心回顾性研究中，对使用髓内和外固定器治疗感染性膝关节融合术的连续患者进行临床和影像学评估。所有患者均进行了临床评估，包括 X 线检查和问卷调查，内容包括术后至少 12 个月的任何并发症以及分析。
本研究共纳入 152 例患者（75 例女性，77 例男性）。手术时患者的平均年龄为 63.6 岁（12 至 90 岁）。随访时间至少 12 个月（平均 3.1 年，12 至 49 个月）。外固定器固定组（83 例，52.2%）出血量较少，围手术期并发症较少（1.6%），但术后针道感染（35.5%）、松动的钢针（12.7%）和钢针骨折（4.8%）发生率较高，因此存在不稳定和不愈合的风险因素（30.9%）。外固定器固定融合术的翻修率为 22.6%，初次融合率为 65.6%。髓内固定组（69 例，43.4%）的再感染率与外固定器相似（分别为 16.1%和 15.9%），但翻修率明显较低（5.4%，p<0.001）。80%的髓内固定组患者在问卷中对疼痛、功能和日常生活活动的满意度较高。
尽管在问卷调查中患者满意度和日常生活能力方面的结果相似，但与外固定器相比，膝关节髓内固定具有更少的并发症、更低的翻修率和更高的融合率/松动率。
