title: Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects.
abstract: OBJECTIVE
  The present study describes a new temporary arthrodesis procedure, which aims for septic knee prosthesis replacement, in particular for larger bone and soft tissue defects. Our technique offers high stability and full weight-bearing capacity of the knee joint.
  
  
  METHODS
  The study included 16 patients with major bone defects (AORI type IIb or greater) after receiving a radical debridement and a septic two-stage revision total knee arthroplasty. After removing the infected prosthesis and debridement, two AO fixator rods were positioned into the intramedullary space of the femur and tibia. Subsequently, both rods were joined tube-to-tube and adjusted in the center of the knee joint. Finally, the whole cavity of the knee joint was filled with PMMA. The number of previous surgeries, bacterial spectrum, risk factors for further infection and reinfection rates was recorded. Immediately after the temporary arthrodesis, radiographs of the knee with the enclosed spacers were taken in order to compare to previous radiographs and avoiding to miss possible spacer loosening.
  
  
  RESULTS
  Nine of sixteen patients underwent more than two revision surgeries before receiving our new arthrodesis technique. No cases of spacer loosening were observed in all 16 patients; further, there were no peri-implant fractures, and four persistent infections were noted.
  
  
  CONCLUSIONS
  Temporary arthrodesis using AO fixator rods offers a high stability without loosening. Its potential to replace conventional augmentation techniques should be taken into account, particularly in the case of larger bone and tissue defects. In clinical practice, the cemented spacer using AO fixator rods could be an alternative technique for temporary knee arthrodesis after septic debridement.
  
  
  METHODS
  Retrospective case series, Level IV.
authors.affiliation: Department of Traumatology and Orthopaedics, Charité University Hospital, Berlin, Germany. e.roehner@krankenhaus-eisenberg.de.|Department of Orthopaedics, Rudolf-Elle-Hospital, Friedrich-Schiller-University, Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany. e.roehner@krankenhaus-eisenberg.de.
authors.forename: Eric
authors.initials: E
authors.lastname: Röhner
authors.affiliation: Department of Traumatology and Orthopaedics, Charité University Hospital, Berlin, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Pfitzner
authors.affiliation: Department of Traumatology and Orthopaedics, Charité University Hospital, Berlin, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Preininger
authors.affiliation: Department of Traumatology and Orthopaedics, Charité University Hospital, Berlin, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Zippelius
authors.affiliation: Department of Traumatology and Orthopaedics, Charité University Hospital, Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Perka
mesh_terms: D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001858:Bone Nails; D001862:Bone Resorption / Q000209:etiology / Q000601:surgery; D003646:Debridement; D005260:Female; D005269:Femur / Q000601:surgery; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis / Q000009:adverse effects / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery; D016474:Weight-Bearing
keywords: AO fixator rods; Septic knee prosthesis replacement; Temporary arthrodesis