Outcomes of Transfemoral Osseointegration for Patients With Prior Amputation to Manage Infected Total Knee Arthroplasty.

IF 1.6 4区 医学 Q3 ORTHOPEDICS
Tyler D DeSena, LaYow C Yu, S Robert Rozbruch, Taylor J Reif, Jidapa Wongcharoenwatana, Jason S Hoellwarth
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引用次数: 0

Abstract

Background: Management of total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can prompt knee fusion or transfemoral amputation, both associated with poor mobility. The titanium transcutaneous osseointegrated nail (TiTON) provides superior mobility versus traditional socket prostheses but has been minimally studied for amputees with prior TKA PJI. Purpose: This study investigated the complications and mobility experience of 9 transfemoral osseointegration patients whose initial amputation was for TKA PJI management. Methods: A retrospective review of a prospectively maintained registry was conducted of 9 patients whose unilateral transfemoral osseointegration was performed following TKA PJI. Complications associated with the implantation of the titanium implant were noted, specifically antibiotic prescription or any additional surgery. K-level mobility performance before and after osseointegration was also compared. Results: Three patients (33.3%) had management for an infectious concern: 2 had a 10-day course of oral doxycycline for periportal drainage, and 1 had operative debridement with implant retention. No other complications (periprosthetic fracture, implant removal, and additional amputation) occurred. Eight patients (88.9%) improved their K-level, while 1 remained at K3. None declined. All achieved at least K2. Three patients were wheelchair-bound (K0) before osseointegration and achieved K3 or better. Conclusions: While infection may occur in patients who have TiTON following TKA PJI, our findings suggest that it does not seem inevitable, severe, or likely to further disable the patient. We noted meaningful mobility improvement that was common and lasting. Although our sample was small, we suggest that TiTON seems safe and reasonable to offer to patients seeking improved mobility and quality of life after amputation for TKA PJI management. Further study is warranted.

经股骨骨整合治疗先前截肢患者感染全膝关节置换术的结果。
背景:全膝关节置换术(TKA)假体周围关节感染(PJI)的处理可促使膝关节融合或经股截肢,两者都与活动能力差有关。钛经皮骨整合钉(TiTON)与传统的窝形假体相比具有优越的移动性,但对于先前患有TKA PJI的截肢患者的研究很少。目的:研究9例经股骨融合患者的术后并发症及活动经验。方法:对9例在TKA PJI后进行单侧经股骨融合的患者进行前瞻性的回顾性研究。与钛种植体植入相关的并发症被注意到,特别是抗生素处方或任何额外的手术。比较骨融合前后的k水平迁移性能。结果:3例患者(33.3%)因感染问题接受了治疗,2例患者接受了10天的口服强力霉素门静脉周围引流,1例患者接受了手术清创并保留种植体。无其他并发症(假体周围骨折、假体移除和额外截肢)发生。8例(88.9%)患者k水平改善,1例维持在K3水平。没有拒绝。所有人都至少达到了K2。3例患者在骨融合前为轮椅束缚(K0),并达到K3或更高。结论:虽然感染可能发生在TKA PJI后发生TiTON的患者中,但我们的研究结果表明,这似乎不是不可避免的,严重的,也不可能进一步导致患者残疾。我们注意到有意义的流动性改善是普遍和持久的。虽然我们的样本很小,但我们认为TiTON似乎是安全合理的,可用于TKA PJI治疗的截肢后寻求改善活动能力和生活质量的患者。值得进一步研究。
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来源期刊
Hss Journal
Hss Journal Medicine-Surgery
CiteScore
3.90
自引率
0.00%
发文量
42
期刊介绍: The HSS Journal is the Musculoskeletal Journal of Hospital for Special Surgery. The aim of the HSS Journal is to promote cutting edge research, clinical pathways, and state-of-the-art techniques that inform and facilitate the continuing education of the orthopaedic and musculoskeletal communities. HSS Journal publishes articles that offer contributions to the advancement of the knowledge of musculoskeletal diseases and encourages submission of manuscripts from all musculoskeletal disciplines.
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