Abstract. Introduction. Knee arthrodesis is one of the treatment options for limb salvage of a failed total knee replacement (TKR) when further revisions were contraindicated. The aim of this study is to determine patient outcomes after knee arthrodesis (KA) following a failed TKR. Methodology. A literature search was conducted for studies published from January 2000 through January 2022 via Medline, Web of Science, Embase and Cochrane databases. Only primary research studies were included with independent extraction of articles by two reviewers. Results were synthesised by narrative review according to PRISMA guidelines, with full tabulation of all included study results. Results. A total of 34 studies with 1,034 patients were included in the review; all were longitudinal observational studies, and none were conducted as randomised controlled trials. Reporting methods were very inconsistent in the included studies, and this heterogeneity led to pooled data totals that varied widely in different categories. The mean follow-up was 3.5 years. Overall, 72.0% (167 of 232) of patients used a walking stick and 12.5% (36 of 287) remained non-ambulatory after KA. Only 7.7% (58 of 752) of patients subsequently underwent above-knee amputation. Conclusion. KA is a potential limb salvage procedure after revision arthroplasties have been attempted in cases of failed TKR. Most patients were able to ambulate both at home and in the community, although with an increased rate of using a walking stick after the operation. However, in the absence of randomised controlled trials, these data may allow for a more accurate counselling and decision making

The August 2012 Oncology Roundup. 360. looks at: prolonged symptom duration; peri-operative mortality and above-knee amputation; giant cell tumour of the spine; surgical resection for Ewing’s sarcoma; intercalary allograft reconstruction of the femur for tumour defects; and an induced membrane technique for large bone defects

Introduction. The burden of peri-prosthetic joint infection (PJI) following hip and knee surgery is increasing. Endoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. Aims. To determine clinical outcome of EPRs for treatment of PJI around the hip and knee joint. Methods. This was a retrospective consecutive case-series of hip and knee EPRs between 2007–2014 in our tertiary unit for the treatment of PJI following complex arthroplasty or fracture fixation. Data recorded included indication for EPR (infected primary/revision arthroplasty, infected non-union/failed osteosynthesis, gross bone loss following native joint infection), number of previous surgeries, and organism identified. Outcome measures included PJI eradication rate (with failure defined as EPR revision, amputation, or being on life-long suppressive antibiotics), complications, implant survival, mortality, and functional outcome (Oxford Hip/Knee Score; OHS/OKS). Results. 58 EPRs (32 knee and 26 hip) were performed with a mean age of 68 years (range: 35–92). The mean number of previous surgeries prior to EPR was 3.4 (range: 1–10). At mean follow-up of 3.5 years, 11 (19%) patients were deceased. EPR was implanted as a two-stage procedure in 76% of cases. Plastic surgical involvement and flap coverage was necessary in 11 cases. Polymicrobial growth was detected in 40% of cases, followed by Coagulase-negative staphylococci (26%). The overall complication rate was 40%. Recurrence of infection post-EPR occurred in 14 patients (24%); 5 were treated with Debridement, Antibiotics and Implant Retention (DAIR), 3 with revision, 1 with above-knee amputation and the remaining 6 remained on long-term suppressive antibiotics. PJI eradication was achieved in 44 (76%) cases (69% knees and 85% hips). Of the remaining 14 cases, 9 remain on long-term antibiotics. The complication rate was similar in knees (41%) and hips (38%). PJI eradication was more successful in hips (85%) compared to knees (69%). To date, 6 EPRs have been revised (10%). The overall 5-year implant survivorship was 83% (95% CI: 68–98%). The mean OHS was 25 (range 7–39.) and the mean OKS was 20 (range 6–43), the best possible score being 48. Conclusions. This mid-term study provides further support for the use of massive endoprostheses in the eradication of PJI in complex, previously multiply revised cases with subsequent limb salvage (in all but one case). We describe PJI eradication rate of 76% with acceptable functional outcomes. This eradication rate is comparable to that following treatment of PJI associated with standard arthroplasty

Periprosthetic infection is a challenging complication of total knee arthroplasty (TKA) which reported incidence varies from 1 to 2% in primary TKA and 3–5% in revision TKA. Persistent infection of TKA may benefit from knee arthrodesis when all reconstruction options have failed. Knee arthrodesis also demonstrated better functional results and pain relief than other salvage procedures such as above-knee amputation. The purpose of this study was to analyze treatment results in patients who underwent knee arthrodesis following infected TKA. Retrospective study with review of the data of all patients treated in our department with knee arthrodesis for chronic infection of knee arthroplasty between 2009 and 2014. Clinical and radiographic data were evaluated as well as several variables: technique used, fusion rate, time to fusion, need for further arthrodesis and complications. Patients with less than 8 months of follow-up were excluded from this study. 46 patients were treated with knee arthrodesis in our department from 2009 to 2014 for chronic infection of total knee arthroplasty. The sample included 26 (57%) women and 20 (43%) men, median age of 70 years. In 45 patients, the technique used was compressive external fixation, while an intramedullary modular nail was used in 1 patient. Mean follow-up of these patients was 35 months (8–57). Primary knee fusion was obtained in 32 (70%) patients with a mean time to fusion of 5,8 months (4–9). 9 (20%) patients needed rearthrodesis and 7 (15%) ultimately achieved fusion. 33 (72%) patients underwent knee arthrodesis in a single surgical procedure, while 13 (28%) firstly removed knee arthroplasty and used a spacer before arthrodesis. Overall complication rate was 35%; 7 (15%) patients experienced persistent infection and 4 (9%) of these undergone above knee amputation. Treatment of septic total knee replacement is a surgical challenge. Compressive external fixation was the method of choice to perform knee arthrodesis following chronic infected TKA. Although complication rate was worrisome, overall fusion rate was satisfactory and this arthrodesis method can be safely performed in one stage

This was a retrospective study of all patients with soccer injuries admitted to our orthopaedic unit over 42 months. Patients treated as outpatients were assessed for purposes of comparison. Thirty-two patients were admitted with severe injuries, including 18 fractures of the tibial and femoral shaft. Two tibial shaft fractures were compound. There were four tibial plateau fractures and five epiphyseal injuries. One patient had a fracture dislocation of the hip. One patient with a popliteal artery injury, who presented 48 hours after a soccer injury, underwent an above-knee amputation. In the same period, 122 patients were treated as outpatients. The types of injuries in this group were similar to soccer injuries reported in other countries. Very serious injuries are sustained in community soccer players in South Africa and urgent measures need to be taken to prevent such injuries

Introduction: Non-invasive expandable prostheses for limb salvage tumour surgery was first used in 2002 and has now been implanted in a series of 40 skeletally immature patients. Method: Our review of these includes 24 distal femoral replacements, 5 proximal femoral replacements, 3 total femoral replacements and 8 proximal tibial replacements. These were used to treat 31 osteosarcomas, 7 Ewing’s sarcomas, 1 chondrosarcoma and 1 aneurysmal bone cyst. Patients had a mean age of 11.7 years (7–16). Follow-up extended to 88 months with a mean of 26.3 months. Results: There has been 1 failure of the prosthesis gearbox which required revision surgery. 4 of the prostheses reached their maximum length and were successfully re-operated to exchange components of the prosthesis and resume lengthening. 3 patients had disseminated meta-static disease (1 being present before primary surgery) and another developed infection of the prosthesis that required an above-knee amputation. There have been 233 lengthenings overall with 1 patient requiring reversal on one occasion due to intractable pain; this pain rescinded 30 minutes after lengthening was reduced by 10mm. Otherwise lengthening was well tolerated despite the significant growth of the limbs: mean 21.2mm (0.5–84mm). At latest follow-up the mean Musculoskeletal Tumour Society score was 75% (26–93%). Discussion: The results achieved are equivalent to our series of minimally invasive growers which require repeated surgery. Our non-invasive growing prostheses remain reliable and negate the need for recurrent operations, thus resulting in low infection rates. Our results remain encouraging up to 7 years after first use, maintaining leg-length equality and function

Purpose. Rotationplasty was first described in 1930 by Borggreve for treatment of limb shortening with knee ankylosis after tuberculosis. In 1948, Van Nes described its use for management of congenital defects of the femur and in the 1980s, Kotz and Salzer reported on patients with malignant bone tumors around the knee treated by rotationplasty as an alternative to above-knee amputation. Currently, rotationplasty is one of the options for surgical management of lower extremity bone sarcomas in skeletally immature patients but alternative limb salvage techniques, such as the use of expandable endoprosthesis, are also available. Despite rather satisfactory functional results have been uniformly associated with rotationplasty, concern still exists about the potential psychological impact of the new body imagerelated to the strange appearance of the rotated limb. Results of rotationplasty for sarcomas of the distal femur over a 20-year period were analyzed, focusing on long-term survival, function, quality of life and mental health. Method. Retrospective study of 73 children who had a rotationplasty performed at two institutions between 1984 and 2007 for a bone sarcoma of the distal femur; 42 males and 31 females, mean age at surgery 8.7 yrs (range 3–17). Four patients were converted to transfemoral amputation due to early vascular complication; 25 eventually died of their disease (mean survival 34 months, range 4–127). The 46 remaining survivors were evaluated for updated clinical outcome, MSTS score, gait analysis, SF-36 score, quality of life interview and psychological assessment at mean follow-up of 15 yrs (range 3–23). Results. Overall survival was 64%. All the survivors were disease-free at last follow-up. Four patients required hardware revision for nonunion and subsequently healed. Three patients refused participation in the long-term follow-up study. Mean MSTS score was 79 (range 64–88). SF-36 score was obtained in 35 patients (age > 16); male patients showed a trend toward greater activity and vitality. Compared to age-group norms, rotationplasty scores were lower for physical activity level (p <0.05) and higher for general health perception (p = 0.05) and mental health (p < 0.05). Conclusion. Rotationplasty remains a durable reconstructive option with good long-term function and acceptable psychological impact for children with bone sarcomas of the distal femur

Introduction: Deep infection following distal femoral endoprosthetic replacement remains an uncommon, (< 7%), but serious complication; we present the results all three-phase revisions performed at our unit. Method: Using the endoprosthesis-survivorship database we identified and analysed 15 consecutive cases, (including MSTS functional assessment of all available patients), performed between 1993 and 2002. The primary replacement had been performed for trauma and fourteen for limb reconstruction following excision of tumour. All cases underwent a three-phase revision. The first stage involved debridement and exchange of prosthesis for a custom-made antibiotic-impregnated spacer. Following at least six weeks of intravenous antibiotics, a further endoprosthesis was inserted. Results: Eight patients had complete clinical, radiological & biochemical resolution of infection, (mean follow-up 60 months). Mean MSTS score for this group was 83% (range 60–97%). The remaining seven had recurrence of infection, all within 18 months. Of this group, two underwent a successful second revision procedure with conversion to a total femoral replacement. Two cases are satisfactorily managed with antibiotic suppression therapy and three have required amputation. Two of these cases underwent above-knee amputation following a failed second revision, whilst the third was given a femoral stump endoprosthesis to avoid disarticulation. Revision was generally more successful in younger patients. Neither the original pathology nor the timing of revision surgery appeared to affect outcome. Negative tissue cultures from the first stage were associated with a successful result. Very high levels of inflammatory markers were associated with failure of revision. Conclusion: We recommend two-stage revision of distal femoral replacement as an effective treatment for infection, allowing limb salvage with excellent functional outcome in the majority of patients. The antibiotic phase may need to exceed six weeks in certain cases, and levels of inflammatory markers appear to be critical. If this revision fails, conversion to a total femoral replacement should be considered

Aim: The aim of the study is to evaluate the results of the use of the Rotating Knee Endo Model not only as a revision implant, but as a primary choice too. Method: It is a retrospective study of 73 patients who underwent primary total knee replacement (TKR) in 96 knees, during 1990–2001. The mean follow up is 5.6 years. The average age of the patients was 70.6 years (38 – 87 years), and 79.6 % were female. The indications for surgery were osteoarthritis in 66 knees, rheumatoid arthritis (R.A.) in 10 knees and aseptic osteonecrosis of femoral condyles in 3 knees. Seventy-nine prosthesis were examined both clinically and with plain films. Fifteen patients died in the mean time and 2 others could not participate in the follow up. The pre- and post-operative evaluation based on the «The Hospital for Special Surgery (HSS) knee rating scale». Results: Fifty-eight knees were rated as excellent, 13 knees were rated as good and 8 knees were rated as fair. Deep venous thrombosis occured in 3 patients, non-fatal pulmonary embolism in 2, and 3 patients demonstrated superficial wound infection cured with oral antibiotic administration. One patient suffered dislocation of the apparatus, which required revision of the femoral component. The tibial insertion of the patellar tendon of one patient detached, which was reattached. Ectopic ossification was present in another patient 4 months after surgery and excised in a second stage, deep infection in 1 patient with history of osteomyelitis silent for 10 years, who eventually underwent an above-knee amputation. Conclusions: The Rotating Knee Endo Model allows axial correction of the extremity, stabilization of the joint, useful range of motion and pain relief while the infection rate is considered low. So the prosthesis could be a good alternative not only in revision procedures but in primary TKA in cases of serious axial deformity and in rheumatoid knees with instability and muscular atrophy as well

Aims

Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications.

Aims

Safety concerns surrounding osseointegration are a significant barrier to replacing socket prosthesis as the standard of care following limb amputation. While implanted osseointegrated prostheses traditionally occur in two stages, a one-stage approach has emerged. Currently, there is no existing comparison of the outcomes of these different approaches. To address safety concerns, this study sought to determine whether a one-stage osseointegration procedure is associated with fewer adverse events than the two-staged approach.

Aims

Dead-space management, following dead bone resection, is an important element of successful chronic osteomyelitis treatment. This study compared two different biodegradable antibiotic carriers used for dead-space management, and reviewed clinical and radiological outcomes. All cases underwent single-stage surgery and had a minimum one-year follow-up.

Aims

Orthopaedic surgeries are complex, frequently performed procedures associated with significant haemorrhage and perioperative blood transfusion. Given refinements in surgical techniques and changes to transfusion practices, we aim to describe contemporary transfusion practices in orthopaedic surgery in order to inform perioperative planning and blood banking requirements.

Despite of improved operative technique, ultra-clean air in the operating theater and systemically administered as well as in bone cement loaded antibiotics, septic complications after replacement arthroplasty of the knee still exist. Depending of the follow-up time in different reported series insidence vary from 0.5 to 5 per cent. Classic clinical symptoms, painful, swollen knee joint, possibly fever, indicate to more accurate examinations. Lesson to learn: . No treatment before adequate diagnosis !. No “homeostatic” antibiotics before accurate examinations. If the very first contact with physician or surgeon happens in such conditions, that adequate diagnostic methods are not available, patient has to be referred to hospital or institution with capable facilities. Prosthetic infection can be classified in many ways. The following classification is useful for the treatment purposes. Classification of infection:. 1. Early postoperative infection less than 4 weeks after surgery. superficial. deep. extensive soft tissue defects due to skin necrosis. 2. Originally patient is operated for aseptic loosening, but intraoperative cultures are positive. 3. Late chronic infection. 4. Acute hematogenous infection. Diagnostic methods:. 1. Clinical examination:. - symptoms can be suppressed by painkillers or immunomodulant drugs. - wound healing problems. - sinuses. - swelling, redness. - pain. - temperature increased. 2. Blood chemistry:. ESR, C-reactive protein and blood white cell count/ differentiation are helpful. Be ware if the patient has such a general disease, which increases fex CRP. 3. Routine x-rays. In early cases no significant signs, in late cases might appear erosions or cysts. 4. Isotope scintigraphy. Technetium- or indium labeled leucosytes are given intravenously. The patient is scanned 24 hours. Extended scintigraphy seems to be more sensitive than routine 6 to 8 hours‘ scintigraphy. 5. Joint aspiration. One has to sure, that the patient is not on antibiotics. If she/he is, antibiotics has to be stopped for two to four weeks, and aspiration performed after that, unless infection is not clinically obvious or situation is not life-threatening. White cell count/differentiation can be for some help. When the cell count is less than 2000/ml, and majority of cells are mononuclear, the result is indicative negative for infection. White cell count over 10000/ml, and majority polymorphonuclear, speaks for infection. When the aspiration has been carried in aseptic condition, positive culture is strong evidence for infection. Adequate handling of sample is important: as little as possible air in the syringe and as short as possible time used for transportation to lab. Treatment protocols. Treatment protocols can rather straight forward: if any sample culture is positive,. Two-stage revision arthroplasty is carried out. But also more conservative opinions are reported. 1.a. Early postoperative, superficial infection:. Surgical débridement of the wound. Careful examination of retinaculum layer. Lavage and wound closure if possible. Systemic antibiotics. Joint puncture and aspiration through healthy skin area, never through open wound. b. Early postoperative, deep infection:. Open débridement and careful lavage with retention of prosthesis. Additional peroperative samples for culture in order to confirm earlier pathogene definition. Systemic antibiotics regarding sensitivity estimation. Arthroscopic debridement and lavage has not proved to be better or neither as good as open. New aspiration 4–6 days after. If white cell count clearly over 10000/ml and possibly culture positive, new debridement and lavage. If third debridement comes necessary, even without bony changes, removal of prosthesis and antibiotics- loaded spacer has to be considered. c. Dehiscense of wound or soft tissue defect due to the necrosis:. Wound débridenent, antibiotics and depending on the extend of defect either partial closure, skin grafting or pedicled gastrocnemius muscle flap is performed. 2. In some cases there is no signs of infection, and the is operated as an aseptic loosening. In all revision, routineously 4 to 5 tissue samples should be taken for culture. If preoperatively there is any doubts about infection, histological examination of frozen sections should be carried out. If there are high count of polymorphonuclear cells, results of culture has to be waited. If later on in minimum two samples same pathogen is growing, the case has to be considered as infected. Two-stage revision protocol is recommended. One positive sample cannot be regarded as a concluding proof. Long term antibiotics is recommended. 3. Late chronic infection has insidious , slowly progressing onset. Symptoms can be confusing mild, and can lead to misdiagnosis. Method of choice is débridement, removal of the prosthesis and all bone cement, and placement of an antibiotics-loaded cement spacer. No dead space is left , but has to be filled with antibiotic-loaded collagen or antibiotic-cement beads. The patient is put on systemic antibiotics, preferably combination of two. Antibiotic therapy is continued six- to eight weeks. Healing process is controlled with ESR and CRP tests. If the blood test normal and clinical situation is normal, delayed revision arthroplasty is performed. Antibiotic loaded-cement is always used. 4. Acute hematogenous infection. Onset is usually acute and symptoms dramatic. Sometimes distant focus can be found. If the history is rather short( less than 14 days) open débridement, retainment of prosthesis, antibiotics-loaded collagen filling of the joint as well systemic antibiotics is recommended. Recovering is monitored by blood chemistry and repeated joint aspiration and cultures. If in aspiration sample there is high polymorphonueclear count and culture possibly positive, new débridemand is carried out. If signs of infection still continue, two-stage exchange to be considered. Pathogenes. Gram-positive. staphylococci are most frequent patogene in total knee replacement infections (95%). Gram-negative. bacilli cover the rest (5%). Coagulase-negative staphylococci has grown up the most important bacteria, and it‘s resistance against antibiotics has turned frightening. Spacers. In cases with short history retainment of prosthesis can be considered. Many authors change of polyethylene bearing. In two-stage revisions static antibiotic-loaded cement spacer was used during. The six to eight weeks‘ interval. Static spacer is connected with extensive bone loss as well as stiff causing problems in secondary revision. Molded cement spacer is used in order to avoid complications and to achieve better functional results. Failure. In some cases treatment of infection is unsuccessful. Arthodesis with method of Ilizarov or intramedullary nail or sometimes above-knee amputation comes necessary

Aims

This study evaluates risk factors influencing fracture characteristics for postoperative periprosthetic femoral fractures (PFFs) around cemented stems in total hip arthroplasty.

Aims

The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland.

Periprosthetic joint infection (PJI) is one of the most feared and challenging complications following total knee arthroplasty. We provide a detailed description of our current understanding regarding the management of PJI of the knee, including diagnostic aids, pre-operative planning, surgical treatment, and outcome.

Cite this article: Bone Joint J 2015;97-B(10 Suppl A):20–9.