Abstract
Sepsis following total knee replacement (TKR) is a disastrous complication. The knee arthrodesis comes as the final solution to solve the chronic infection after multiple failed surgeries. Our objective was to review these procedures performed in our institution for the past 20 years.
We present a retrospective study with 5 cases of severe unsolved knee infection after TKR, who have been finally submitted to knee arthrodesis performed between 1993 and 2008. The patients are 4 males and 1 female, with a mean age of 62 years (ranging from 55 to 74 years) at the time of surgery. They presented MRSA infection (3 cases), P aeruginosa infection (1 case) and Mycobacterium tuberculosis (1 case). The average follow up was 25 months (between 12–48 months). The Visual Analogic Scale (VAS) value was registered.
The mean number of surgeries before the arthrodesis was 3,6. In 4 of the 5 cases the surgeon used an external fixator to achieve the fusion. In the other patient, an intramedullary nail was used. The arthrodesis was performed in a single-time surgery in every patient. All cases achieved knee fusion and the mean time of consolidation was 5,1 months, with the longest being 8 months until fusion. No bone graft was used in any of these cases, and the mean size of leg length discrepancy was 2,8 cm. The average VAS was 3,6. In one patient with an external fixator there was a relapse of the infection (MRSA infection), but with adequate antibiotic therapy (vancomycin) ended up to resolve. There are no records of any other complication.
The knee arthrodesis appears as last but useful resort in extreme cases of relapse infection after a TKR and multiple unsuccessful surgeries. Although it comprises an elevated level of morbidity, it also seems to allow to heal difficult and multi resistant infections and with few complications.
