J Bone Jt Infect 2020; 5(4):176-183. doi:10.7150/jbji.46570

Research Paper

Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up

Asim M. Makhdom1✉, Joshua Buksbaum2,3, S. Robert Rozbruch2, Rachael Da Cunha4, Austin T. Fragomen2

1. Foothills Medical Group, Upper Alleghany Health System, Olean, NY and Bradford, PA, USA.
2. Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA.
3. SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, NY, USA.
4. Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada.
✉ Corresponding author: Asim M. Makhdom, MD, MSc, FRCSC. Attending Orthopaedic Surgeon, Olean, NY and Bradford, PA, USA; 195 Pleasant St, Bradford, PA, 16701; Tel: +1 814 362 5701; E-mail: makhdoma@brmc.com.

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Citation:
Makhdom AM, Buksbaum J, Rozbruch SR, Da Cunha R, Fragomen AT. Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up. J Bone Jt Infect 2020; 5(4):176-183. doi:10.7150/jbji.46570. Available from http://www.jbji.net/v05p0176.htm

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Abstract

Background: To report on our experience with antibiotic cement coated interlocking intramedullary nails (ACC-IMNs) for limb salvage in septic complex lower extremity reconstruction with a minimum of 2-year follow up.

Methods: We retrospectively reviewed the records of all consecutive patients who underwent a limb salvage procedure with ACC-IMNs. We reviewed patients' demographics, the preoperative infecting organism, and host type, time to bone union, complications, limb salvage rates, and infection control rates.

Results: There were 28 patients with a mean age of 62 years (range 22-88). The mean follow up period was 40 months (range 28-84). The ACC-IMNs were used in 14 patients (50 %) to achieve knee fusion after failed revisions of infected total knee arthroplasty, in 8 patients (28%) for septic tibial nonunion, and in 6 patients (21%) with ankle fusion nonunions. Bony union/fusion was achieved in 87 % (21/24) of patients. The infection was controlled in 80% (21/26) of patients. Four out the five patients who had recurrent infection were type B hosts (p=0.63). The limb salvage rate was 89% (25/28). The overall complication rate was 32%.

Conclusions: The use of ACC-IMNs was an effective treatment strategy and associated with high limb salvage and bone union rates. Furthermore, the infection recurrence rate was low. Knee fusion patients after failed TKA should be counseled preoperatively for a potential high complication rate.

Keywords: antibiotic cement coated interlocking intramedullary nails, arthroplasty