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
. 2022 Aug 11;6(8):e22.00082.
doi: 10.5435/JAAOSGlobal-D-22-00082. eCollection 2022 Aug 1.

Outcomes of Second-stage Reimplantation After Modular Knee Arthrodesis for Periprosthetic Joint Infection

Alexandra Stavrakis  1 , Erik N Mayer, Sai Devana, Madhav Chowdhry, Matthew Dipane, Edward McPherson
Affiliations

Outcomes of Second-stage Reimplantation After Modular Knee Arthrodesis for Periprosthetic Joint Infection

Alexandra Stavrakis et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Background: Modular knee arthrodesis (MKU) is a salvage treatment for recurrent periprosthetic joint infection (PJI) or PJI associated with notable bone loss. Reimplantation endoprosthetic reconstruction (REI) is an option in patients with MKU who have PJI clearance but are not satisfied with pain or functional outcomes with MKU. The purpose of this study was to evaluate the outcomes of MKU to REI conversion.

Methods: This was a single-center retrospective cohort study of 56 patients who underwent MKU to REI from 2010 to 2019. All patients were staged according to the McPherson staging system. An infecting organism was documented based on pre-MKU aspiration or intraoperative cultures at the time of MKU. Rate ratios were calculated for relevant patient factors. Rate ratios were calculated using Poisson regression with a log link.

Results: The mean REI patient age was 67 years, most of the patients were McPherson B hosts (62.5%) with a type 2 (46.4%) or type 3 (51.8%) limb score, and all PJI were chronic. The most common infecting organisms at the time of MKU were Staphylococcus epidermidis (23.2%) and Staphylococcus aureus (23.2%, MSSA 14.3%, MRSA 8.9%). The mean time from MKU to REI was 220 days. An 8.9% REI index hospitalization complication rate and a 21.4% overall complication rate (excluding reinfection) were observed. Sixty-seven percent of the patients remained infection-free at an average follow-up of 37 months, among those there was 96.4% implant survivorship. No notable association was observed between index PJI organism or McPherson staging and REI failure secondary to PJI.

Discussion: Approximately two thirds of patients who undergo conversion from MKU to REI have infection-free survival at the midterm follow-up. An index infecting organism and a McPherson host type do not seem to be markedly associated with reinfection risk. These findings help guide expectations of PJI MKU conversion to REI.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Preoperative AP and lateral views demonstrating the right knee pre-MKU. MKU = modular knee arthrodesis
Figure 2
Figure 2
Postoperative AP and lateral views demonstrating the right knee post-MKU. MKU = modular knee arthrodesis
See this image and copyright information in PMC

References

    1. Conway JD, Mont MA, Bezwada HP: Arthrodesis of the knee. J Bone Joint Surg Am 2004;86:835-848. - PubMed
    1. Gottfriedsen TB, Schrøder HM, Odgaard A: Knee arthrodesis after failure of knee arthroplasty: A Nationwide Register-based study. J Bone Joint Surg Am 2016;98:1370-1377. - PubMed
    1. MacDonald JH, Agarwal S, Lorei MP, Johanson NA, Freiberg AA: Knee arthrodesis. J Am Acad Orthop Surg 2006;14:154-163. - PubMed
    1. Wiedel JD: Salvage of infected total knee fusion: The last option. Clin Orthop Relat Res 2002;404:139-142. - PubMed
    1. 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;470:2737-2745. - PMC - PubMed

MeSH terms