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

Andrea Sambri; Giuseppe Bianchi; Michael Parry; Filippo Frenos; Domenico Campanacci; Davide Donati; Lee Jeys

doi:10.1055/s-0038-1672121

The Journal of Knee Surgery, Table of Contents

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

¹Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

,

Giuseppe Bianchi

¹Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

,

Michael Parry

²Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom

,

Filippo Frenos

³Department of Orthopedic Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy

,

Domenico Campanacci

³Department of Orthopedic Oncology, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy

,

Davide Donati

¹Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

,

Lee Jeys

²Department of Orthopedic Oncology, Royal Orthopaedic Hospital, Birmingham, United Kingdom

› Author Affiliations

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

Full Text

References

References
1 Jeon DG, Kawai A, Boland P, Healey JH. Algorithm for the surgical treatment of malignant lesions of the proximal tibia. Clin Orthop Relat Res 1999; (358) 15-26
2 Ek EW, Rozen WM, Ek ET, Rudiger HA. Surgical options for reconstruction of the extensor mechanism of the knee after limb-sparing sarcoma surgery: an evidence-based review. Arch Orthop Trauma Surg 2011; 131 (04) 487-495
3 Wang TY, Dormans JP, Chang B. Soft-tissue optimization of limb salvage with knee endoprosthesis: the 10-year experience at the Children's Hospital of Philadelphia. Ann Plast Surg 2012; 69 (05) 560-564
4 Grimer RJ, Carter SR, Tillman RM. , et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br 1999; 81 (03) 488-494
5 Mavrogenis AF, Pala E, Angelini A, Ferraro A, Ruggieri P. Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol 2013; 107 (04) 335-342
6 Capanna R, Scoccianti G, Frenos F, Vilardi A, Beltrami G, Campanacci DA. What was the survival of megaprostheses in lower limb reconstructions after tumor resections?. Clin Orthop Relat Res 2015; 473 (03) 820-830
7 McDonald DJ, Capanna R, Gherlinzoni F. , et al. Influence of chemotherapy on perioperative complications in limb salvage surgery for bone tumors. Cancer 1990; 65 (07) 1509-1516
8 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (8, Suppl): 61-65
9 Neut D, van Horn JR, van Kooten TG, van der Mei HC, Busscher HJ. Detection of biomaterial-associated infections in orthopaedic joint implants. Clin Orthop Relat Res 2003; (413) 261-268
10 Ercolano LB, Christensen T, McGough R, Weiss K. Treatment solutions are unclear for perimegaprosthetic infections. Clin Orthop Relat Res 2013; 471 (10) 3204-3213
11 Osmon DR, Berbari EF, Berendt AR. , et al; Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56 (01) e1-e25
12 Del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med 2009; 361 (08) 787-794
13 Parvizi J, Gehrke T. ; International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty 2014; 29 (07) 1331
14 Flint MN, Griffin AM, Bell RS, Wunder JS, Ferguson PC. Two-stage revision of infected uncemented lower extremity tumor endoprostheses. J Arthroplasty 2007; 22 (06) 859-865
15 Harris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am 1990; 72 (10) 1477-1485
16 Wilding CP, Cooper GA, Freeman AK, Parry MC, Jeys L. Can a silver-coated arthrodesis implant provide a viable alternative to above knee amputation in the unsalvageable, infected total knee arthroplasty?. J Arthroplasty 2016; 31 (11) 2542-2547
17 Chen AF, Kinback NC, Heyl AE, McClain EJ, Klatt BA. Better function for fusions versus above-the-knee amputations for recurrent periprosthetic knee infection. Clin Orthop Relat Res 2012; 470 (10) 2737-2745
18 Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 2013; 95-B (11) 1450-1452
19 Donati D, Biscaglia R. The use of antibiotic-impregnated cement in infected reconstructions after resection for bone tumours. J Bone Joint Surg Br 1998; 80 (06) 1045-1050
20 Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res 2002; 395: 193-203
21 Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 2005; 87 (04) 842-849
22 Friedrich MJ, Schmolders J, Wimmer MD. , et al. Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency. Knee 2017; 24 (05) 1240-1246
23 Gottfriedsen TB, Schrøder HM, Odgaard A. Knee arthrodesis after failure of knee arthroplasty: a nationwide register-based study. J Bone Joint Surg Am 2016; 98 (16) 1370-1377
24 Putman S, Kern G, Senneville E, Beltrand E, Migaud H. Knee arthrodesis using a customised modular intramedullary nail in failed infected total knee arthroplasty. Orthop Traumatol Surg Res 2013; 99 (04) 391-398
25 Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg Am 2006; 88 (06) 1285-1293
26 Albergo JI, Gaston CL, Aponte-Tinao LA. , et al. Proximal tibia reconstruction after bone tumor resection: are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar?. Clin Orthop Relat Res 2017; 475 (03) 676-682
27 Schmolders J, Koob S, Schepers P. , et al. Lower limb reconstruction in tumor patients using modular silver-coated megaprostheses with regard to perimegaprosthetic joint infection: a case series, including 100 patients and review of the literature. Arch Orthop Trauma Surg 2017; 137 (02) 149-153
28 Hardes J, von Eiff C, Streitbuerger A. , et al. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 2010; 101 (05) 389-395
29 Wafa H, Grimer RJ, Reddy K. , et al. Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: case-control study. Bone Joint J 2015; 97-B (02) 252-257
30 Mavrogenis AF, Pala E, Angelini A. , et al. Infected prostheses after lower-extremity bone tumor resection: clinical outcomes of 100 patients. Surg Infect (Larchmt) 2015; 16 (03) 267-275
31 Garcia-Lopez I, Aguayo MA, Cuevas A, Navarro P, Prieto C, Carpintero P. Knee arthrodesis with the Vari-Wall nail for treatment of infected total knee arthroplasty. Acta Orthop Belg 2008; 74 (06) 809-815
32 Fedorka CJ, Chen AF, McGarry WM, Parvizi J, Klatt BA. Functional ability after above-the-knee amputation for infected total knee arthroplasty. Clin Orthop Relat Res 2011; 469 (04) 1024-1032
33 Furtado S, Grimer RJ, Cool P. , et al. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey. Bone Joint J 2015; 97-B (09) 1284-1290
34 Röhner E, Windisch C, Nuetzmann K, Rau M, Arnhold M, Matziolis G. Unsatisfactory outcome of arthrodesis performed after septic failure of revision total knee arthroplasty. J Bone Joint Surg Am 2015; 97 (04) 298-301
35 Tan TL, Kheir MM, Tan DD, Parvizi J. Polymicrobial periprosthetic joint infections: outcome of treatment and identification of risk factors. J Bone Joint Surg Am 2016; 98 (24) 2082-2088