Levent ERALP, Mehmet KOCAOĞLU, İbrahim TUNCAY, F. Erkal BİLEN, Shady Elbeshry SAMİR

Enfeksiyon sekeli tedavisinde unilateral eksternal fiksatör ile diz artrodezi

Amaç: Diz bölgesinin septik sekellerinin tedavisinde monolateral eksternal fiksatör kullanılarak yapılan artrodez tekniğinin sonuçları değerlendirildi. Çalışma planı: Monolateral eksternal fiksatör kullanılarak diz artrodezi uygulanan 11 hasta (4 erkek, 11 kadın; ort. yaş 60; dağılım 29-75) geriye dönük olarak değerlendirildi. Altı hastada enfekte total diz protezi, dört hastada septik artrit sekeli, bir hastada enfekte distal femur modüler tümör protezi vardı. Aktif enfeksiyon bulunan sekiz hastanın yedisinde artrodez, debridman, antibiyotikli çimento uygulaması (n=6) ve parenteral antibiyoterapi ile enfeksiyon klinik ve laboratuvar bulguları tamamen kaybolduktan sonra uygulandı. Femur ve tibiada kanayan geniş bir kemik yüzeyi oluşturmak için total diz protezi uygulama setindeki rezeksiyon kızakları kullanıldı. Biplanar veya uniplanar monolateral eksternal fiksasyon ortalama sekiz ay (dağılım 5-12 ay) uygulandı. Hastalar ortalama 28 ay (dağılım 7-69 ay) izlendi. Komplikasyonların değerlendirilmesi için Paley sınıflaması kullanıldı. Sonuçlar: Tüm hastalarda eksternal fiksasyon sonunda füzyon elde edildi. Enfeksiyon nüksü görülmedi. Hiçbir hastada artrodez tekniğinden kaynaklanan istenmeyen kısalık görülmedi. Geniş tümör rezeksiyonu nedeniyle belirgin kısalık oluşan ve artrodezden sonra uzatma uygulanan bir hasta dışında, tüm hastalar desteksiz yürüyebildi. Enfekte total diz protezi olan bir hastada kısalık 3 cm bulunurken, geri kalan hastalarda 1-2 cm arasında (ort. 1.4 cm) değişiyordu. Beş hastada görülen çivi dibi enfeksiyonu oral antibiyotik ve yara bakımı ile başarıyla tedavi edildi. Çıkarımlar: Monolateral fiksatör ile uygulanan diz artrodezinin füzyon oranı yüksek, komplikasyonları daha azdır; bu yöntem, sirküler eksternal fiksatörlere göre daha konforlu bir tedavi seçeneği oluşturmaktadır.

Anahtar Kelimeler:

Eksternal fiksatörler, Cerrahi yara enfeksiyonu, Artrodez, Anti-bakteriyel ajanlar, Tedavi sonucu, Proteze bağlı enfeksiyonlar, Artroplasti, replasman, diz, Debridman, Reoperasyon, Diz protezi

Knee arthrodesis using a unilateral external fixator for the treatment of infectious sequelae

Objectives: We evaluated the results of arthrodesis using a monolateral external fixator for the treatment of septic sequelae of the knee joint. Methods: Eleven patients (4 males, 7 females; mean age 60 years; range 29 to 75 years) underwent arthrodesis using a monolateral external fixator. Indications for arthrodesis were infected total knee prosthesis (n=6), septic arthritis sequelae (n=4), and infected distal femoral tumor prosthesis (n=1). Eight patients had active infection; of these, seven patients initially underwent complete clinical and laboratory eradication of infection with debridement, application of antibioticimpregnated cement spacer (n=6), and parenteral antibiotics. Resection guides of total knee arthroplasty were used to create wide bleeding femoral and tibial bone surfaces. Biplanar or uniplanar monolateral external fixation was applied for a mean of eight months (range 5 to 12 months). The mean follow- up was 28 months (range 7 to 69 months). Complications were evaluated according to the Paley’s classification. Results: Fusion was achieved in all the patients. There were no recurrent infections. No remarkable shortening developed following the procedure. All the patients could walk without walking aids, except for one patient who further required lengthening for marked shortening due to previous wide tumor resection. Shortening was 3 cm in one patient with infected total knee prosthesis, while it ranged from 1 cm to 2 cm (mean 1.4 cm) in the remaining patients. Pin tract infections were seen in five patients, all of which were successfully treated with oral antibiotics and local wound care. Conclusion: Knee arthrodesis using a monolateral external fixator is associated with a high fusion rate and a low complication rate, and provides a more comfortable treatment option compared to a circular external fixator.

Keywords:

External Fixators, Surgical Wound Infection, Arthrodesis, Anti-Bacterial Agents, Treatment Outcome, Prosthesis-Related Infections, Arthroplasty, Replacement, Knee, Debridement, Reoperation, Knee Prosthesis,

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