2023 ISAKOS Biennial Congress ePoster
Modular Knee Arthrodesis as Definitive Treatment for Periprosthetic Infection, Bone Loss, and Failure of the Extensor Mechanism after Total Knee Arthroplasty
Gloria Shoshana Coden, MD, Boston, MA UNITED STATES
Maksym Bartashevskyy, BA, Boston, MA UNITED STATES
Zachary Berliner, MD, Boston, MA UNITED STATES
Ruijia Niu, MPH, Boston, MA UNITED STATES
James V. Bono, MD, Roxbury Crossing, MA UNITED STATES
Ayesha Abdeen, MD, Boston, MA UNITED STATES
Eric L. Smith, MD, Boston, MA UNITED STATES
New England Baptist Hospital, Boston, MA, UNITED STATES
FDA Status Cleared
Summary
Modular knee arthrodesis is a viable definitive treatment option for patients with resolved periprosthetic infection, severe bone loss, and failure of the extensor mechanism not amenable to repair after total knee arthroplasty.
ePosters will be available shortly before Congress
Abstract
Introduction
Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) can result in bone and soft tissue loss, leg length discrepancies, and dysfunctional extensor mechanisms. While above knee amputation (AKA) is an established salvage treatment, modular knee arthrodesis (MKA) is a viable option that provides rigid stability and maintains leg length even in patients with severe bone and soft tissue loss. We sought to report the outcomes of patients with a MKA as definitive treatment.
Methods
We retrospectively reviewed 8 patients implanted with a MKA at two institutions between 2014 and 2022. Mean age was 69.4 years and 50.0% of patients were women. All patients were indicated for conversion to a MKA as definitive treatment in the setting of treated chronic PJI after TKA, severe bone loss, and failure of the extensor mechanism not amenable to repair. All patients were offered an AKA as an alternative but chose MKA after discussing the risk and benefits. Medical records and radiographs were reviewed.
Results
No patients required exchange of their MKA for PJI at mean 2-year follow-up. One patient required 2 revisions for mechanical failure of his implant at 7 and 8.5 years postoperatively.
Discussion
MKA is a viable permanent alternative to AKA for patients with treated chronic PJI and dysfunctional extensor mechanism after TKA. The procedure restores leg lengths in the setting of severe bone and soft tissue loss, therefore allowing patients to ambulate independently. Still, surgeons should be aware of the potential for mechanical failure requiring revision.