Abstract
Purpose
To demonstrate experience of bone transport arthrodesis of the knee with simultaneous lengthening in the treatment of infected peri-articular fracture fixation associated with large condylar defects.
Methods
Four patients (3 male/1 female), mean age 46.5 years (37–57 y) with post-traumatic osteomyelitis involving the knee were treated by radical debridement, removal of all metalwork and frame application. Substantial condylar defects resulted (6–10 cm) with loss of extensor mechanism. Parenteral antibiotics were administered for several weeks. Two patients required muscle flaps. Bone transport was utilised to achieve an arthrodesis whilst simultaneously lengthening. In three cases a ‘peg in socket’ construct was fashioned to ensure stability of the arthrodesis.
Results
Arthrodesis was successfully achieved in all patients at an average time of 25 months (range 19–31 months). The median number of interventions undertaken was 9 (range 8–12). The mean limb length discrepancy at end of treatment was 3 cm (range 3–4 cm). No infection has recurred after a minimum 2 year follow up. Patient factors had considerable influence on the time spent in frame; two patients developed DVT; one complicated by PE, and two required surgical correction of equinus contracture using frames.
Conclusion
Bone loss is associated with reduction in the success rate of any arthrodesis. In this series the bone efects were associated with established infection which further compromises bone healing. However, by optimising the host environment with eradication of infection, ensuring well vascularised soft tissue coverage, and using Ilizarov techniques to overcome the bony defect, one can provide a stable arthrodesis and limb salvage.
