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Successful treatment of active septic knee arthritis with severe chondrolysis or end stage OA with a two stage TKA concept

Published in N°19 - September / October 2022
Article viewed 79 times

Successful treatment of active septic knee arthritis with severe chondrolysis or end stage OA with a two stage TKA concept

By Siegfried Hofmann, Michael Eder-Halbedl, Oliver Djahani, Markus Hochegger, Martin Pietsch in category TECHNIQUE
Orthopedic Hospital Murtal-Stolzalpe 8852 Stolzalpe, Austria [email protected]

Native septic knee arthritis (SA) is rare with an incidence of 10 per 100.000, but the knee is involved in 50% of the cases. Knee SA represents a constantly evolving surgical issue and diagnosis and therapy remains complex. SA might occur after surgery, posttraumatic or hematogenous spread.

Introduction

Native septic knee arthritis (SA) is rare with an incidence of 10 per 100.000, but the knee is involved in 50% of the cases [1]. Knee SA represents a constantly evolving surgical issue and diagnosis and therapy remains complex [2]. SA might occur after surgery, posttraumatic or hematogenous spread [3]. A second scenario includes patient with already existing OA which develop iatrogenic infection after intraarticular injection [4]. Therapeutic options include arthroscopic or open lavage and debridement combined with long term AB therapy [1]. Still up to 10 % of this therapy fails especially in posttraumatic cases and these patients develop progressive severe chondrolysis due to not controlled infection [5]. Furthermore, 25 to 50 % of patients who had knee SA in the past develop severe OA during their life span [6] .

Since these patients have severe pain and lost there QuoL arthrodesis or resection arthroplasty were the only therapeutic options in the past [3]. Arthrodesis with a well-functioning extensor mechanism is not a good option and resection arthroplasty of the knee can be recommended for wheelchair bound patients only.  On the other hand, TKA was not an option in the past since an acute or persistent infection of a native knee was regarded as a classical...

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