JBJS Editor’s Choice—Knee Fusion: Not a Safety Net after Infection-Related TKA Failures

In the February 18, 2015 issue of The Journal, Rohner et al. report their experience with knee arthrodesis using an intramedullary rod as the definitive treatment for failed total knee arthroplasties (TKAs) related to infection. They report the results for 26 patients treated between 1997 and 2013 who had undergone an average of 6 ±3 knee procedures prior to arthrodesis.

The outcomes for this cohort of patients are sobering. Persistent infection requiring additional surgery remained in 50% of the patients. The health-related quality-of-life measures and functional outcomes were abysmal, and 73% reported persistent pain at greater than 3 on the VAS. Obesity, high blood pressure, and diabetes were strong predictors of reinfection.

Many of us have taken comfort that knee fusion, by whatever surgical technique, is a reliable “bail out” for the problem of recurrent infection following revision of a loose or infected TKA. Nevertheless, any surgeon who has followed a patient with a knee fusion is fully aware of the functional disability associated with the stiff knee. Difficulties using public transportation and impaired sitting are just two inconveniences that these patients express unhappiness about.

Despite its retrospective design and relatively small number of cases, this report may cause the knee-reconstruction community to reconsider knee arthrodesis and instead attempt further staged revisions of the knee prosthesis. It may even prompt a slightly earlier move toward recommending trans-femoral amputation. It certainly will stimulate further research into infection prevention and into developing more predictable approaches for revising infected TKA prostheses.

Marc Swiontkowski, MD

JBJS Editor-in-Chief

One thought on “JBJS Editor’s Choice—Knee Fusion: Not a Safety Net after Infection-Related TKA Failures

  1. I found this article both interesting and informative. I was trained in the 70’s that a knee fusion was the standard bail out for a septic knee. In no way would I dispute the findings of this study. However, I would like to comment on Dr. Swiontowski’s remarks concerning the functional disability of a stiff knee. I believe the latter would be preferable to the disability resulting from an A-K amputation in an elderly, obese,diabetic. I don’t claim to have the answer, but trust that the unfortunate surgeon confronted with this decision will carefully consider all the options before operating and spend time discussing them with the patient. In this hi-tech world we live in we physicians should never lose the skill to communicate and empathize with the patient.

    Martin Pomphrey, M.D.

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