Outcome of Knee Joint Arthrodesis as a Salvage Procedure After Periprosthetic Infection: An Analysis of 41 Patients

Abstract

AIM: There has been little scientific evidence regarding knee joint arthrodesis as a salvage procedure in patients with periprosthetic infections.

METHODS: We performed a retrospective clinical and radiological follow-up at least 1-year post-surgery in patients who had received knee joint arthrodesis between 2007 and 2012. Clinical follow-up was conducted using the WOMAC and SF-36 questionnaires.

RESULTS: A total of 41 consecutive patients were included with an average age of 69 years (range 36-90). In 24/41 patients (59%), arthrodesis was conducted using a modular prosthesis. In 14 patients (34%) bilateral double-plate osteosynthesis was used, and in 3 patients (7%) an external fixator. During the further course, 15/41 patients (37%) experienced complications that required revision, including subsequent above knee amputation (total 4 patients; 10%). Finally, radiological and clinical follow-up was possible in 18/41 patients (44%) after an average of 42 months (range 12-65) post-surgery. Clinical follow-up was conducted using the WOMAC and SF-36 questionnaires, and there was demonstrated a significant impairment of physical function, which was independent from the type of arthrodesis and leg length differences. Compared to a healthy reference population, the social function and psychological subscore were not impaired.

CONCLUSION: Knee joint arthrodesis is a suitable salvage procedure in patients with chronic periprosthetic knee joint infections. We recommend the use of a double-plate osteosynthesis in patients with lesser bone loss and a modular prosthesis in larger defects. Both methods are prone to complications, and it is not always possible to prevent amputation during the further course of events.