knee arthrodesis with ilizarov apparatus. maurizio a.catagni, luigi lovisetti

Knee Arthrodesis with Ilizarov Apparatus

Maurizio A.Catagni, Luigi Lovisetti

Ospedale A. ManzoniLecco - Italia

Knee Arthrodesis with Knee Arthrodesis with Ilizarov ApparatusIlizarov Apparatus

Maurizio Maurizio A.CatagniA.Catagni, Luigi , Luigi LovisettiLovisetti

OspedaleOspedale A. ManzoniA. ManzoniLecco Lecco -- ItaliaItalia M. A. CatagniM. A. CatagniM. A. Catagni

Ospedale LeccoOspedale Lecco

M. A. CatagniM. A. CatagniM. A. Catagni


Infection in TKR represents one of the most challenging problem to be solved by the orthopaedicsurgeon: even if the mean

incidence reported in literature is very low (1-2%), many

different treatments have been proposed

Infection in TKR represents one Infection in TKR represents one of the most challenging problem of the most challenging problem to be solved by the to be solved by the orthopaedicorthopaedicsurgeon: even if the mean surgeon: even if the mean

incidence reported in literature incidence reported in literature is very low (1is very low (1--2%), many 2%), many

different treatments have been different treatments have been proposed proposed

In many cases the situation is complicated by poor bone

stock, soft tissue compromise, limb shortening and/or axial

deformity

In many cases the situation is In many cases the situation is complicated by poor bone complicated by poor bone

stock, soft tissue compromise, stock, soft tissue compromise, limb shortening and/or axial limb shortening and/or axial

deformitydeformity



Revision arthroplasty is not always possible or desired by the patient while a resection arthroplasty is not well

tolerated by young patients with high physical demands

Revision Revision arthroplastyarthroplasty is not is not always possible or desired by always possible or desired by the patient while a resection the patient while a resection arthroplastyarthroplasty is not well is not well

tolerated by young patients tolerated by young patients with high physical demands with high physical demands



In selected patients a knee fusion is a salvage

procedure which can offer a practical solution to these

problems

In selected patients a knee In selected patients a knee fusion is a salvage fusion is a salvage

procedure which can offer a procedure which can offer a practical solution to these practical solution to these

problems problems



Different techniques for performing a successful knee arthrodesis have been proposed by different authors. Internal fixation, either with a plate or an IM nail (modular or not), provides rigid fixation but with

high risk of infection

Different techniques for Different techniques for performing a successful knee performing a successful knee arthrodesis have been proposed arthrodesis have been proposed by different authors. Internal by different authors. Internal fixation, either with a plate or fixation, either with a plate or an IM nail (modular or not), an IM nail (modular or not), provides rigid fixation but with provides rigid fixation but with

high risk of infectionhigh risk of infection



The IM nail permits, according to recent reports, early weight-bearing with no need for an

additional immobilization but it not possible respect the

mechanical axis of the lower limb

TheThe IM nail permits, according IM nail permits, according to recent reports, early weightto recent reports, early weight--bearing with no need for an bearing with no need for an

additional immobilizationadditional immobilization but it but it not possible respect the not possible respect the

mechanical axis of the lower mechanical axis of the lower limblimb



IM Nail:wrong mechanical

axis: varus deformity

IM Nail:IM Nail:wrong mechanical wrong mechanical

axisaxis: varus : varus deformitydeformity



External fixation offers some potential advantages including: possible progressive adjustment to stimulate the bone fusion and to correct malalignment, no risk of intramedullary dissemination of the infection, easy removal

of the hardware

EExternalxternal fixation offers some fixation offers some potential advantages including: potential advantages including: possible progressive adjustment possible progressive adjustment to stimulate the bone fusion and to stimulate the bone fusion and to correct to correct malalignmentmalalignment, no risk , no risk of of intramedullaryintramedullary dissemination dissemination of the infection, easy removal of the infection, easy removal

of the hardwareof the hardware



Particularly with the Ilizarov Method, the possibility to combine knee fusion with a limb lengthening/correction through a proximal and/or distal limb osteotomy

Particularly with the Ilizarov Particularly with the Ilizarov Method, the possibility to Method, the possibility to combine knee fusion with a combine knee fusion with a limb lengthening/correction limb lengthening/correction through a proximal and/or through a proximal and/or distal limb osteotomy distal limb osteotomy



Surgical approach as the previous TKR, the prosthesis components were removed and wide, accurate debridmentswith multiple washings were

performed

Surgical approach as the Surgical approach as the previous TKR, the prosthesis previous TKR, the prosthesis components were removed and components were removed and wide, accurate wide, accurate debridmentsdebridmentswith multiple washings were with multiple washings were

performedperformed



Standard frame:The apparatus is preassembled before starting the surgery sizing the rings directly on patient’s limb. In the

monofocal treatment (arthrodesis only without any lengthening) we

generally use for the femur a proximal 90° arch and 1 distal ring, with 2 rings

for the tibia, all connected with threaded rods

Standard frame:Standard frame:The apparatus is preassembled before The apparatus is preassembled before starting the surgery sizing the rings starting the surgery sizing the rings directly on patientdirectly on patient’’s limb. In the s limb. In the

monofocalmonofocal treatment (arthrodesis only treatment (arthrodesis only without any lengthening) we without any lengthening) we

generally use for the femur a proximal generally use for the femur a proximal 9090°° arch and 1 distal ring, with 2 rings arch and 1 distal ring, with 2 rings

for the tibia, all connected with for the tibia, all connected with threaded rodsthreaded rods



Bone grafts only in one patient after failure of the fist Ilizarov treatment(no more infection)

Bone grafts only in one Bone grafts only in one patient after failure of the patient after failure of the fist Ilizarov treatmentfist Ilizarov treatment(no more infection)(no more infection)



Protesi cementata infetta

Protesi cementata Protesi cementata infettainfetta



Protesi infetta trattata con sintesi interna E FEA

Protesi infetta trattata con sintesi interna Protesi infetta trattata con sintesi interna E FEAE FEA M. A. CatagniM. A. CatagniM. A. Catagni


Rimozione mezzi di sintesi, fissazione temporanea con fili di K e Ilizarov

Rimozione mezzi di sintesi, fissazione Rimozione mezzi di sintesi, fissazione temporanea con fili di K e Ilizarovtemporanea con fili di K e Ilizarov M. A. CatagniM. A. CatagniM. A. Catagni


Compressione sul ginocchioCompressione sul ginocchioCompressione sul ginocchioM. A. CatagniM. A. CatagniM. A. Catagni


ConsolidazioneConsolidazioneConsolidazioneM. A. CatagniM. A. CatagniM. A. Catagni


Protesi infetta trattata con fissatori esterni e poi placca (infetta)

Protesi infetta trattata con fissatori esterni Protesi infetta trattata con fissatori esterni e poi placca (infetta)e poi placca (infetta) M. A. CatagniM. A. CatagniM. A. Catagni


Rimozione placca, fili K temporanei

e Ilizarov

Rimozione placca, Rimozione placca, fili K temporanei fili K temporanei

e Ilizarove IlizarovM. A. CatagniM. A. CatagniM. A. Catagni


Consolidazione: infezione scomparsa

Consolidazione: infezione Consolidazione: infezione scomparsascomparsa M. A. CatagniM. A. CatagniM. A. Catagni


Infected Knee

Infected Infected KneeKnee



Hardware removalKnee compression

and 2 level lengthening: femur and tibia

Hardware removalHardware removalKnee compression Knee compression

and 2 level and 2 level lengthening: lengthening: femur and tibiafemur and tibia



Hardware removalKnee compression

and 2 level lengthening: femur

and tibia

Hardware removalHardware removalKnee compression Knee compression

and 2 level and 2 level lengthening: femur lengthening: femur

and tibiaand tibia



Fusion failureFusion Fusion failurefailure



Second fusion attempt with patella transport

Second fusion Second fusion attempt with attempt with patella patella transporttransport



Secondfusion failure

SecondSecondfusion fusion failurefailure



•Revision•Bone graft•Compression

••RevisionRevision••Bone graftBone graft••CompressionCompression



Clinical appearanceClinical Clinical appearanceappearance



Final result:stablefusion

Final result:Final result:stablestablefusionfusion



Final clinical result

Final Final clinical clinical resultresult



Infection and fracture of proximal tibia

Infection and fracture of Infection and fracture of proximal tibiaproximal tibia



Large resection of necrotic and infected bone

Large resection of necrotic Large resection of necrotic and infected boneand infected bone



During the treatmentDuring the treatmentDuring the treatment



Knee fusionKnee fusionKnee fusion



Clinical resultClinical resultClinical result



In all six patients we obtained a stable knee

arthrodesis mean external fixation time of 6,8 months

(range: 5,1-18,3)

In all six patients we In all six patients we obtained a stable knee obtained a stable knee

arthrodesis mean external arthrodesis mean external fixation time of fixation time of 66,8 months ,8 months

(range: 5,1(range: 5,1--1818,3) ,3)



No patient developed further infections through previous sinuses, and we observed a

complete soft tissue recovery.

All the patients were satisfied about the treatment. Pain relief allowed all the patients

to return to a more normal life style

No patient developed further infections No patient developed further infections through previous sinuses, and we observed a through previous sinuses, and we observed a

complete soft tissue recovery.complete soft tissue recovery.

All the patients were satisfied about the All the patients were satisfied about the treatment. Pain relief allowed all the patients treatment. Pain relief allowed all the patients

to return to a more normal life styleto return to a more normal life style



Knee arthrodesys in different disease

Knee Knee arthrodesysarthrodesys in in different diseasedifferent disease



Knee arthritisKnee arthritisKnee arthritis M. A. CatagniM. A. CatagniM. A. Catagni


Resection, fixation and femoral and tibial lengthening

Resection, fixation Resection, fixation and femoral and and femoral and tibial lengtheningtibial lengthening



At the end of lengtheningAt the end of At the end of lengtheninglengthening



Closed fractureClosed fracture


Necrotic bone sandwichNecrotic bone sandwich M. A. CatagniM. A. CatagniM. A. Catagni

Ilizarovianattempt

Ilizarovianattempt


Frame removalFrame removal M. A. CatagniM. A. CatagniM. A. Catagni

DebridmentDebridment


2 level transport2 level transportM. A. CatagniM. A. CatagniM. A. Catagni

Revision at the docking and knee

fusion

Revision at the docking and knee

fusion


Final X-raysFinal X-raysM. A. CatagniM. A. CatagniM. A. Catagni

Final resultFinal resultM. A. CatagniM. A. CatagniM. A. Catagni

One year follow-upOne year follow-up M. A. CatagniM. A. CatagniM. A. Catagni

ConclusionThe Ilizarov fixator provides, with

progressive distraction and compression force, a mechanical stimulus for bone formation, without risk of further infection and with a possibility to eliminate

any deformity and LLD

ConclusionConclusionThe Ilizarov fixator provides, with The Ilizarov fixator provides, with

progressive distraction and progressive distraction and compression force, a mechanical compression force, a mechanical stimulus for bone formation, stimulus for bone formation, without risk of further infection without risk of further infection and with a possibility to eliminate and with a possibility to eliminate

any deformity and LLDany deformity and LLD



Obrigado…. se desperta!!!Obrigado…. se desperta!!! M. A. CatagniM. A. CatagniM. A. Catagni

knee arthrodesis with ilizarov apparatus. maurizio a.catagni, luigi lovisetti

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