Giovanni Francesco Raspugli

Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA

INTRODUCTION Knee arthrodesis can be an effective treatment after an infected revision Total Knee Arthroplasty (TKA). The main hypothesis of this study is that a two-stage arthrodesis of the knee using a press-fit, modular intramedullary nail and antibiotic loaded cement, to fill the residual gap between the bone surfaces, prevents an excessive limb shortening, providing satisfactory clinical and functional results even without direct bone-on-bone fusion. MATERIAL AND METHODS The study included 22 patients who underwent knee arthrodesis between 2004 and 2009 because of recurrent infection following revision-TKA (R-TKA). Clinical and functional evaluations were performed using the Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score. A postoperative clinical and radiographical evaluation of the residual limb-length discrepancy was conducted by three independent observers. RESULTS VAS and LAS results showed a significant improvement with respect to the preoperative condition. The mean leg length discrepancy was less than 1cm. There were three recurrent infections that needed further surgical treatment. DISCUSSION This study demonstrated that reinfection after Revision of total knee Arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail, along with an antibiotic loaded cement spacer and that satisfactory results can be obtained without direct bone-on-bone fusion.

Revision Total Knee Arthroplasty

Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures performed today. This is due to the substantial pain relief and restoration of function after TKA. As result of its success [15, 21], indications for TKA have included younger and more active patients. Therefore, the number of revision TKAs is also rising with a projected increase of 601 % from 2005 to 2030 [14]. Although the results of primary TKAs are well documented with implant survivorship at 15 years greater than 95 % [29], the results of revision procedures are less predictable and encouraging with an 82 % survivorship at 12 years. Predominant revision failure modes include infection (46 %), aseptic loosening (19 %) and instability (13 %) [28].

Arthroscopic-assisted Focal Resurfacing of the Knee With Minimal Bone Resection: Surgical Technique and Preliminary Clinical Results

The main purpose of this paper is to describe a new arthroscopic-assisted surgical technique for focal resurfacing of the medial tibiofemoral compartment. The secondary aim is to present the preliminary clinical and radiographic results in a case series of 13 consecutive patients at a mean follow-up of 29 months. All patients were treated with the presented surgical procedure between November 2006 and March 2007 for Ahlback grade 3 osteoarthritis restricted to the medial tibiofemoral compartment. Subjective evaluation was based on a visual analogue scale for self-assessment of joint pain. Objective clinical evaluation was based on the Hospital for Special Surgery score. Range of motion was evaluated with a manual goniometer. Radiographic evaluation compared hip-knee-ankle angle preoperatively and postoperatively. The presented technique has shown good clinical and functional results. The Hospital for Special Surgery score and visual analogue scale showed a significant improvement (P<0.0001 and P=0.0002, respectively). Range of motion and axial alignment were not significantly modified with respect to preoperative condition. Despite the small sample size and short follow-up, an arthroscopic-assisted procedure for focal resurfacing of the medial compartment of the knee can be a viable option for early-onset osteoarthritis in selected cases, providing good pain relief and functional results at 2-year follow-up.