Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 26:8:46-52.
doi: 10.1016/j.artd.2020.12.008. eCollection 2021 Apr.

Management of Periprosthetic Joint Infection and Extensor Mechanism Disruption With Modular Knee Fusion: Clinical and Biomechanical Outcomes

Wesley H Mayes  1 , Anna C Severin  1 , Erin M Mannen  1 , Paul K Edwards  1 , C Lowry Barnes  1 , Jeffrey B Stambough  1 , Simon C Mears  1
Affiliations

Management of Periprosthetic Joint Infection and Extensor Mechanism Disruption With Modular Knee Fusion: Clinical and Biomechanical Outcomes

Wesley H Mayes et al. Arthroplast Today. .

Abstract

Background: Extensor mechanism disruption (EMD) combined with periprosthetic joint infection (PJI) after total knee arthroplasty are life-changing complications. The literature suggests many eventually receive above-knee amputation and lose ambulatory function. An alternative is modular knee fusion (KF), but little is known about its outcomes and biomechanical function. We report early term results on a case series of patients.

Methods: A retrospective review was conducted of patients who underwent 2-stage reconstruction with modular KF for combined EMD and PJI. Patient-reported outcomes at 1 year after arthrodesis and complications of surgery were recorded. Biomechanical analysis was conducted on 6 patients >1 year after surgery to measure gait speed and balance.

Results: Fifteen patients received a modular KF. At the most recent follow-up visit (average 25.7 months), 12 patients had their modular KFs in place and were ambulatory while 2 had died. Six patients used a walker; 4, a cane; and 2, unassisted. Gait analysis of 6 of these patients showed variation in patterns and speed. Balance was better than historical controls treated with above-knee amputation. Average Knee Injury and Osteoarthritis Outcome Score Junior was 76 ± 11.

Conclusion: Modular KF for EMD and PJI can result in successful outcomes in terms of preventing additional operations and maintaining ambulation. While speed is variable, physical testing shows this method for limb salvage may allow patients to ambulate with a gait aid although further studies are needed to evaluate midterm and long-term results.

Keywords: Extensor mechanism failure; Gait analysis; Knee fusion; Prosthetic joint infection.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Intraoperative photograph demonstrating cementation of proximal and distal stems before placement of the intercalary bodies. Also shown is the large defect that remained after resection and antibiotic spacer placement.
Figure 2
Figure 2
Radiographs of a representative case. Anteroposterior (a) and lateral (b) views depicting presentation, static antibiotic spacer placement, and final construct.
Figure 3
Figure 3
Coronal EOS imaging of same patient from the representative case in Figure 1 at 1 y postoperatively.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Anderson L.A., Culp B.M., Della Valle C.J. High failure rates of concomitant periprosthetic joint infection and extensor mechanism disruption. J Arthroplasty. 2018;33:1879. - PubMed
    1. Hungerer S., Kiechle M., Von Rüden C., Militz M., Beitzel K., Morgenstern M. Knee arthrodesis versus above-the-knee amputation after septic failure of revision total knee arthroplasty: comparison of functional outcome and complication rates. BMC Musculoskelet Disord. 2017;18 - PMC - PubMed
    1. Chalmers B.P., Matrka A.K., Sems S.A. Two-stage arthrodesis for complex, failed, infected total knee arthroplasty. Bone Joint J. 2020;102-B:170. - PubMed
    1. Brown N.M., Murray T., Sporer S.M., Wetters N., Berger R.A., Della Valle C.J. Extensor mechanism allograft reconstruction for extensor mechanism failure following total knee arthroplasty. J Bone Joint Surg Am. 2015;97:279. - PubMed
    1. Browne J.A., Hanssen A.D. Reconstruction of patellar tendon disruption after total knee arthroplasty: results of a new technique utilizing synthetic mesh. J Bone Joint Surg Am. 2011;93:1137. - PubMed

LinkOut - more resources