Salvage Algorithm for Deep Surgical Site Infections after HTO with Unstable Bone Situation Using a Hexapod System - Primary Results.

Heiko Baumgartner, Felix Finger, Marc-Daniel Ahrend, Tina Histing, Leonard Grünwald
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Abstract

The incidence of deep surgical site infections following high tibial osteotomy (HTO) ranges between 0.4 to 4.7%. It is a severe complication with a high risk for poor clinical outcome. The aim of this study was to proof that a salvage algorithm for infected HTO with unstable bone situation leads to an infection-free status and bone union of the osteotomy and that correct limb alignment can be restored with good knee function.The study included seven patients with peri-implant infections following HTO. Infections occurred 83 ± 58.9 days (range: 24-191) after HTO. All patients underwent the "RESTORE" algorithm: patients received (1) REmoval of the HTO hardware and extensive debridement; (2) the osteotomy was STabilized with a hexapod external fixator (Taylor Spatial Frame, TSF); (3) the osteotomy gap was Opened; and (4) the alignment was REconstructed using the TSF, aiming for the intended limb alignment of the initial HTO. Patient-reported outcomes were assessed 22-36 months after removal of the TSF.After 24 weeks (range: 11-35), an infection-free status and bone healing were achieved. In all cases, the limb was saved, and the previously targeted mechanical axis of the lower limb was restored. All patients reached full extension of the knee joint and at least 110° of flexion. For KOOS: Symptoms 67.86 ± 18.1, Pain 73.41 ± 16.58, ADL 78.99 ± 21.32, Sports 52.14 ± 25.96, and QoL 41.96 ± 24.66. OKS 35.71 ± 8.8, SF-12 Physical Health 38.89 ± 10.3, and SF-12 Mental Health 46.86 ± 13.76.The "RESTORE" algorithm is a safe and effective salvage procedure. The concept allows for saving the limb and obtaining the previously planned limb alignment. Patient-reported outcome measures showed slightly lowered values than healthy samples, but substantially better values than patients awaiting HTO. Due to the possibility of initial full weight-bearing, the risk of higher morbidity caused by immobilization is minimized.

使用六足系统治疗骨质不稳定的 HTO 后深部手术部位感染的抢救算法 - 初步结果。
高位胫骨截骨术(HTO)后深部手术部位感染的发生率在 0.4% 到 4.7% 之间。这是一种严重的并发症,临床效果不佳的风险很高。本研究的目的是证明,对于骨质情况不稳定的感染性 HTO,挽救算法可导致无感染状态和截骨的骨结合,并可恢复正确的肢体排列和良好的膝关节功能。感染发生在 HTO 后 83 ± 58.9 天(范围:24-191)。所有患者都接受了 "RESTORE "算法:患者接受了(1)HTO硬件的重新移除和大面积清创;(2)用六足外固定器(Taylor Spatial Frame,TSF)稳定截骨;(3)打开截骨间隙;以及(4)使用TSF重新构建对位,以达到最初HTO的预期肢体对位。移除 TSF 后 22-36 个月,对患者报告的结果进行评估。24 周后(范围:11-35),无感染状态和骨愈合得以实现。在所有病例中,肢体都得到了保全,下肢也恢复了之前设定的机械轴线。所有患者的膝关节都能完全伸展,屈曲度至少达到 110°。KOOS:症状(67.86 ± 18.1)、疼痛(73.41 ± 16.58)、ADL(78.99 ± 21.32)、运动(52.14 ± 25.96)和 QoL(41.96 ± 24.66)。OKS为35.71±8.8,SF-12身体健康指数为38.89±10.3,SF-12心理健康指数为46.86±13.76。"RESTORE "算法是一种安全有效的抢救程序,其概念是挽救肢体并获得先前计划的肢体排列。与健康样本相比,患者报告的结果显示数值略低,但与等待 HTO 的患者相比,数值要好得多。由于最初可以完全负重,因此最大限度地降低了因固定而导致发病率升高的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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