Orthopaedic Knowledge Update®: Musculoskeletal Infection 2 Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Section 4: Prosthetic Joint Infections




FIGURE 8 A , AP knee, B , AP tibia, and C , lateral radiographs. The radiographic series show knee arthrodesis with an intramed ullary fusion device including an intercalary segment. This can be used in severe bone loss to prevent significant limb shortening with other arthrodesis instrumentation.

rate of recurrent infection. 71 Follow-up was significantly longer for the arthrodesis group: 9.7 versus 4.2 years. The number of previous revisions and time between the primary arthroplasty and the follow-up surgical proce dure was greater in the transfemoral amputation group. Functional scores (visual analog scale pain, DN4, Parker and Palmer, and 36-Item Short Form scores) were all better in the transfemoral amputation group. Patients who underwent transfemoral amputation had less pain, more autonomy, and higher quality of life than those who underwent arthrodesis. 71,72 Patients who underwent a Girdlestone resection arthroplasty have significantly lower health status and quality-of-life scores than those who did not. A 2018 study reported that patients under going Girdlestone resection had health scores even lower than patients who underwent lower limb amputation or who experienced myocardial infarction. 73

Overall, salvage procedures have worse outcomes than other procedures for hip and knee PJI; however, their use may become necessary when the likelihood of success is so low with other joint revision procedures. SUMMARY The diagnosis and treatment for hip and knee PJI contin ues to evolve because of thoughtful and innovative work of musculoskeletal physicians worldwide. Currently, two-stage revision is the standard in the United States. However, there are often strong indications and success ful outcomes with DAIR and 1.5-stage and single-stage revisions. DAIR is a reasonable option for patients who have acute symptoms or those with implants or medical/ social factors that contraindicate exchange procedures that are more invasive and have higher morbidity. The

Section 4: Prosthetic Joint Infections

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Orthopaedic Knowledge Update ® : Musculoskeletal Infection 2

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