Definitive Resection Arthroplasty of the Knee: A Surprisingly Viable Treatment to Manage Intractable Infection in Selected Patients

Ashton H. Goldman, Nicholas J. Clark, Michael J. Taunton, David G. Lewallen, Daniel J. Berry, Matthew P. Abdel

Research output: Contribution to journalArticle

Abstract

Background: Resection arthroplasty of the hip is considered a viable option after multiple failed attempts to eradicate a prosthetic joint infection (PJI). However, much less information about resection arthroplasty of the knee is available. The goals of this study were to determine the success of infection eradication with a resection arthroplasty of the knee and subsequent functional outcomes in this group. Methods: We retrospectively identified 25 knees (23 patients) treated with resection arthroplasty of the knee for PJI performed at a single institution between 1974 and 2016. The mean age at resection arthroplasty was 65 years. The mean body mass index was 37 kg/m2, and the mean Charleston Comorbidity Index was 5. Patients had a mean of 5 operations on the knee (mean of 3 operations for infection) before the resection arthroplasty. Failure to eradicate the infection was defined as any reoperation for infection. Clinical outcomes were assessed via ambulatory status, use of gait aids, and ongoing pain. The mean follow-up was 4 years. Results: At most recent follow-up, 84% (21 of 25) of knees were free of infection. Three patients had recurrent infection within the first year, and 1 patient had a late infection at 4 years postoperatively. However, only 1 patient required a subsequent amputation. Forty-five percent were community ambulators, 35% were household ambulators, and 20% were only able to transfer. All patients required knee bracing and assistive devices. Fifteen percent of patients were using long-term narcotics. Conclusion: This large series demonstrates the results of selected use of resection arthroplasty as a treatment for recalcitrant periprosthetic knee infections that have failed multiple attempts to eradicate an ongoing PJI. The resection definitively solved the infection in 84% of patients. Functional results were variable but surprisingly good in some. All patients required bracing and assistive devices.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Jan 1 2019

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Knee Replacement Arthroplasties
Infection
Arthroplasty
Knee
Therapeutics
Self-Help Devices
Joints
Narcotics
Knee Joint
Gait
Reoperation
Amputation
Comorbidity
Hip
Body Mass Index

Keywords

  • girdlestone
  • periprosthetic joint infection
  • resection arthroplasty
  • revision total knee arthroplasty
  • salvage

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Definitive Resection Arthroplasty of the Knee : A Surprisingly Viable Treatment to Manage Intractable Infection in Selected Patients. / Goldman, Ashton H.; Clark, Nicholas J.; Taunton, Michael J.; Lewallen, David G.; Berry, Daniel J.; Abdel, Matthew P.

In: Journal of Arthroplasty, 01.01.2019.

Research output: Contribution to journalArticle

Goldman, Ashton H. ; Clark, Nicholas J. ; Taunton, Michael J. ; Lewallen, David G. ; Berry, Daniel J. ; Abdel, Matthew P. / Definitive Resection Arthroplasty of the Knee : A Surprisingly Viable Treatment to Manage Intractable Infection in Selected Patients. In: Journal of Arthroplasty. 2019.
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abstract = "Background: Resection arthroplasty of the hip is considered a viable option after multiple failed attempts to eradicate a prosthetic joint infection (PJI). However, much less information about resection arthroplasty of the knee is available. The goals of this study were to determine the success of infection eradication with a resection arthroplasty of the knee and subsequent functional outcomes in this group. Methods: We retrospectively identified 25 knees (23 patients) treated with resection arthroplasty of the knee for PJI performed at a single institution between 1974 and 2016. The mean age at resection arthroplasty was 65 years. The mean body mass index was 37 kg/m2, and the mean Charleston Comorbidity Index was 5. Patients had a mean of 5 operations on the knee (mean of 3 operations for infection) before the resection arthroplasty. Failure to eradicate the infection was defined as any reoperation for infection. Clinical outcomes were assessed via ambulatory status, use of gait aids, and ongoing pain. The mean follow-up was 4 years. Results: At most recent follow-up, 84{\%} (21 of 25) of knees were free of infection. Three patients had recurrent infection within the first year, and 1 patient had a late infection at 4 years postoperatively. However, only 1 patient required a subsequent amputation. Forty-five percent were community ambulators, 35{\%} were household ambulators, and 20{\%} were only able to transfer. All patients required knee bracing and assistive devices. Fifteen percent of patients were using long-term narcotics. Conclusion: This large series demonstrates the results of selected use of resection arthroplasty as a treatment for recalcitrant periprosthetic knee infections that have failed multiple attempts to eradicate an ongoing PJI. The resection definitively solved the infection in 84{\%} of patients. Functional results were variable but surprisingly good in some. All patients required bracing and assistive devices.",
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AU - Lewallen, David G.

AU - Berry, Daniel J.

AU - Abdel, Matthew P.

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AB - Background: Resection arthroplasty of the hip is considered a viable option after multiple failed attempts to eradicate a prosthetic joint infection (PJI). However, much less information about resection arthroplasty of the knee is available. The goals of this study were to determine the success of infection eradication with a resection arthroplasty of the knee and subsequent functional outcomes in this group. Methods: We retrospectively identified 25 knees (23 patients) treated with resection arthroplasty of the knee for PJI performed at a single institution between 1974 and 2016. The mean age at resection arthroplasty was 65 years. The mean body mass index was 37 kg/m2, and the mean Charleston Comorbidity Index was 5. Patients had a mean of 5 operations on the knee (mean of 3 operations for infection) before the resection arthroplasty. Failure to eradicate the infection was defined as any reoperation for infection. Clinical outcomes were assessed via ambulatory status, use of gait aids, and ongoing pain. The mean follow-up was 4 years. Results: At most recent follow-up, 84% (21 of 25) of knees were free of infection. Three patients had recurrent infection within the first year, and 1 patient had a late infection at 4 years postoperatively. However, only 1 patient required a subsequent amputation. Forty-five percent were community ambulators, 35% were household ambulators, and 20% were only able to transfer. All patients required knee bracing and assistive devices. Fifteen percent of patients were using long-term narcotics. Conclusion: This large series demonstrates the results of selected use of resection arthroplasty as a treatment for recalcitrant periprosthetic knee infections that have failed multiple attempts to eradicate an ongoing PJI. The resection definitively solved the infection in 84% of patients. Functional results were variable but surprisingly good in some. All patients required bracing and assistive devices.

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