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J Knee Surg 2019; 32(09): 911-918
DOI: 10.1055/s-0038-1672121
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

Andrea Sambri
1   Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
,
Giuseppe Bianchi
1   Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
,
Michael Parry
2   Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
,
Filippo Frenos
3   Department of Orthopedic Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
,
Domenico Campanacci
3   Department of Orthopedic Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
,
Davide Donati
1   Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
,
Lee Jeys
2   Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
› Author Affiliations
Further Information

Publication History

14 March 2018

15 August 2018

Publication Date:
18 September 2018 (online)

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Abstract

The aim of this multicentric retrospective study was to verify whether knee arthrodesis (KA) is a viable reconstructive option after two-stage revision for infection of proximal tibia (PT) endoprosthetic reconstruction (EPR). Sixty patients who underwent a two-stage revision were included. Definitive EPR or a KA with a modular system was performed following consideration of soft tissue and extensor mechanism conditions. Patients were evaluated with Musculoskeletal Tumor Society Score and Oxford Knee Score. Implant survival was assessed on the basis of recurrence of infection. Five patients did not receive any reconstruction after the first stage. In 14 cases, a KA was performed, and in 41, an EPR was implanted. At 5 years follow-up, reinfection rate in the KA group was lower (10 vs. 17.5% in KA and EPR groups, respectively). In reinfected patients, the KA group had a reduced rate of amputation when compared with those with EPR (50 vs. 88%). Functional evaluation did not show any significant differences between the two groups. A successful KA using a modular implant can eradicate infection and allow preservation of the limb with good function and good pain relief in after two-stage revision for an infected PT EPR.

Keywords

infection - proximal tibia - endoprosthetic replacement - knee arthrodesis - bone - sarcoma
 

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