Knee Arthrodesis with

Ilizarov Apparatus
Maurizio A.Catagni
A.Catagni,, Luigi Lovisetti

Ospedale A. Manzoni
Ospedale Lecco Lecco - Italia M.
M.A.
A.Catagni
Catagni
 Infection in TKR represents one
of the most challenging problem
to be solved by the orthopaedic
surgeon: even if the mean
incidence reported in literature
is very low (1 -2%), many
(1-2%),
different treatments have been
proposed

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 In many cases the situation is
complicated by poor bone
stock, soft tissue compromise,
limb shortening and/or axial
deformity

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Revision arthroplasty is not
always possible or desired by
the patient while a resection
arthroplasty is not well
tolerated by young patients
with high physical demands

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 In selected patients a knee
fusion is a salvage
procedure which can offer a
practical solution to these
problems

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Different techniques for
performing a successful knee
arthrodesis have been proposed
by different authors. Internal
fixation, either with a plate or
an IM nail (modular or not),
provides rigid fixation but with
high risk of infection
M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 The IM nail permits, according
to recent reports, early weight
weight--
bearing with no need for an
additional immobilization but it
not possible respect the
mechanical axis of the lower
limb
M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 IM Nail:
wrong mechanical
axis
axis:: varus
deformity

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 E xternal fixation offers some
External
potential advantages including:
possible progressive adjustment
to stimulate the bone fusion and
to correct malalignment
malalignment,, no risk
of intramedullary dissemination
of the infection, easy removal
of the hardware
M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Particularly with the Ilizarov
Method, the possibility to
combine knee fusion with a
limb lengthening/correction
through a proximal and/or
distal limb osteotomy

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Surgical approach as the
previous TKR, the prosthesis
components were removed and
wide, accurate debridments
with multiple washings were
performed

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Ospedale Lecco

Standard
Standard frame:
frame:
The
The apparatus
apparatus isis preassembled
preassembled beforebefore
starting
starting the
the surgery
surgery sizing
sizing the
the rings
rings
directly
directly on on patient ’s limb.
patient’s limb. InIn the
the
monofocal
monofocal treatment
treatment (arthrodesis
(arthrodesis onlyonly
without
without any any lengthening)
lengthening) we we
generally
generally use
use forfor the
the femur
femur aa proximal
proximal
90 ° arch
90° arch and
and 11 distal
distal ring,
ring, with
with 22 rings
rings
for
for the
the tibia,
tibia, all
all connected
connected with with
threaded
threaded rodsrods

M.
M.A.
A.Catagni
Catagni
 Bone grafts only in one
patient after failure of the
fist Ilizarov treatment
(no more infection)

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Protesi
Protesicementata
cementata
infetta
infetta

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Protesi
Protesi infetta
infetta trattata
trattata con
con sintesi
sintesi interna
internaM.M.A.A.Catagni
Catagni
Ospedale Lecco EE FEA
FEA
 Rimozione
Rimozione mezzi
mezzi di
di sintesi,
sintesi, fissazione
fissazione M.M.A.A.Catagni
Catagni
Ospedale Lecco temporanea con fili di K e Ilizarov
temporanea con fili di K e Ilizarov
 Compressione
Compressione sul
sul ginocchio
ginocchio M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Consolidazione
Consolidazione M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Protesi
Protesi infetta
infetta trattata
trattata con
con fissatori
fissatori esterni
esterniM.M.A.A.Catagni
Catagni
Ospedale Lecco ee poi placca (infetta)
poi placca (infetta)
 Rimozione
Rimozione placca,
placca,
M.
fili
fili K
K temporanei
temporanei
M.A.
A.Catagni
Catagni
ee Ilizarov
Ilizarov
Ospedale Lecco
 Consolidazione:
Consolidazione: infezione
infezione
Ospedale Lecco scomparsa
scomparsa
M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Infected
Knee

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Hardware removal
Knee compression
and 2 level
lengthening:
femur and tibia

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Hardware removal
Knee compression
and 2 level
lengthening: femur
and tibia

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Fusion
failure

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Second fusion
attempt with
patella
transport
M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Second
fusion
failure

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

••Revision
Revision
••Bone
Bone graft
••Compression
Compression

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Clinical
appearance

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Final
Final result:
result:
stable
stable
fusion
fusion

M.
M.A.
A.Catagni
Catagni
 Ospedale Lecco

Final
Final
clinical
clinical
result
result

M.
M.A.
A.Catagni
Catagni
 Infection and fracture of
proximal tibia

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Large resection of necrotic
and infected bone

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 During the treatment

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Knee fusion

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Clinical result

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 In all six patients we
obtained a stable knee
arthrodesis mean external
fixation time of 66,8
,8 months
(range: 5,1 -18,3)
5,1-18,3)

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 No patient developed further infections
through previous sinuses, and we observed a
complete soft tissue recovery.

All the patients were satisfied about the

treatment. Pain relief allowed all the patients
to return to a more normal life style

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Knee arthrodesys in
different disease

M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
Ospedale Lecco
Knee arthritis M.
M.A.
A.Catagni
Catagni
 Resection, fixation
and femoral and
tibial lengthening
M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
 Ospedale Lecco

At the end of
lengthening

M.
M.A.
A.Catagni
Catagni
Closed
Closed
fracture
fracture

M.
M.A.
A.Catagni
Catagni
Necrotic bone sandwich M.
M.A.
A.Catagni
Catagni
Ilizarovian
attempt

M.
M.A.
A.Catagni
Catagni
Frame removal M.
M.A.
A.Catagni
Catagni
Debridment
M.
M.A.
A.Catagni
Catagni
 M.
M.A.
A.Catagni
Catagni
2 level transport
 M.
M.A.
A.Catagni
Catagni

Revision at the
docking and knee
fusion
 M.
M.A.
A.Catagni
Catagni
Final X-rays
Final result
M.
M.A.
A.Catagni
Catagni
One year follow-up M.
M.A.
A.Catagni
Catagni
 Conclusion
The Ilizarov fixator provides, with
progressive distraction and
compression force, a mechanical
stimulus for bone formation,
without risk of further infection
and with a possibility to eliminate
any deformity and LLD
M.
M.A.
A.Catagni
Catagni
Ospedale Lecco
Obrigado…. se desperta!!! M.
M.A.
A.Catagni
Catagni