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Meta-Analysis
. 2018 Oct 10;19(1):361.
doi: 10.1186/s12891-018-2283-4.

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis

Giovanni Balato  1 , Maria Rizzo  2 , Tiziana Ascione  3 , Francesco Smeraglia  2 , Massimo Mariconda  2
Affiliations
Meta-Analysis

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis

Giovanni Balato et al. BMC Musculoskelet Disord. .

Abstract

Background: Knee arthrodesis with intramedullary (IM) nail or external fixator (EF) is the most reliable therapeutic option to achieve definitive infection control in patients with septic failure of total knee arthroplasty (TKA). The first aim of this study was to compare re-infection rates following knee arthrodesis for periprosthetic joint infection (PJI) with IM nail or EF. The second aim was to compare rates of radiographic union, complication, and re-operation as well as clinical outcomes.

Methods: A systematic search was performed in electronic databases for longitudinal studies of PJIs (minimum ten patients; minimum follow-up = 1 year) treated by knee arthrodesis with IM nail or EF. Studies were also required to report the rate of re-infection as an outcome measure. Eligible studies were meta-analyzed using random-effect models.

Results: The rate (95% confidence intervals) of re-infection was 10.6% (95% CI 7.3 to 14.0) in IM nail arthrodesis studies. The corresponding re-infection rate for EF was 5.4% (95% CI 1.7 to 9.1). This difference was significant (p = 0.009). The use of IM nail resulted in more advantages than EF for frequency of major complications and limb shortening. Other postoperative clinical and radiographic outcomes were similar for both surgical strategies.

Conclusions: The available evidence from the aggregate published data suggests that knee arthrodesis with EF in the specific context of PJI has a reduced risk of re-infection in comparison with the IM nail strategy. The use of IM nail is more effective for the complication rate and shortening of the affected limb.

Keywords: External fixator; Intramedullary nail; Knee arthrodesis; Knee arthroplasty; Periprosthetic joint infection; Re-infection.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

All data generated or analyzed during this study are included in this published article.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Literature search and methodology of selection
Fig. 2
Fig. 2
Rates of re-infection in patients treated by knee arthrodesis with intramedullary nail (1 outlier removed [12]). The summary estimates presented were calculated using random-effects models; CI, confidence interval (bars)
Fig. 3
Fig. 3
Rates of re-infection in patients treated by knee arthrodesis with external fixator (1 outlier removed [21]). The summary estimates presented were calculated using random-effects models; CI, confidence interval (bars)
See this image and copyright information in PMC

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