Outcomes of Modular Knee Arthrodesis for Challenging Periprosthetic Joint Infections

• Published in: Arthroplasty today 2022-02, Vol.13, p.199-204
• Main Authors: Stavrakis, Alexandra I., Mayer, Erik N., Devana, Sai K., Chowdhry, Madhav, Dipane, Matthew V., McPherson, Edward J.
• Format: Article
• Language: English
• Subjects: Knee fusion; Original Research; Periprosthetic joint infection
• ISSN: 2352-3441; 2352-3441
• DOI: 10.1016/j.artd.2021.10.015

Modular knee arthrodesis (MKA) is a salvage treatment option for patients with challenging periprosthetic joint infections (PJI). The purpose of this study was to investigate the outcomes of patients who underwent MKA for PJI with a single technique and determine if specific factors are associated with MKA failure. This was a retrospective review of 81 patients who underwent MKA at a single institution. Knee Society Scores were recorded before MKA and at the final follow-up (mean 52 months). Poisson regression was used to calculate rate ratios for MKA failure secondary to infection. The mean patient age was 67 years; most patients were McPherson B hosts (56.8%) and had type 3 extremities (53.1%), and all had a type III infection (chronic, >4 wks). Forty-six percent of patients had a prior explantation (59.5% failed 2-stage, 40.5% failed spacer). Staphylococcus epidermidis and Staphylococcus aureus were the most common organisms, 22.2% and 18.5%, respectively. Thirty percent of patients had at least one reoperation, excluding reimplantation (14.8% irrigation and debridement/wound closure, 9.9% MKA exchange, and 7.4% amputation). Of 82.7% of MKA patients with no evidence of infection, 82.1% (56 patients) underwent reimplantation endoprosthetic reconstruction, and 67.3% of these remained infection-free at the final follow-up. MKA is a salvage option for challenging PJI cases that may serve as definitive surgical management or as a bridge to endoprosthetic reconstruction for patients who have failed prior infection control procedures.