Total Knee Prosthesis after Knee Joint Distraction Treatment

Background and purpose: During knee joint distraction (KJD) treatment, using an external fixation-frame, pin-tract infections frequently occur. These local skin infections, although treated successfully with oral antibiotics, might lead to latent infections. This raises concern about subsequent placement of a total knee prosthesis (TKP). This study evaluates the first five cases in which patients had to be treated with TKO after KJD failure.Patients and methods: An overall survival analysis of the first 26 patients treated with KJD revealed five failures, because of declining efficacy over time. These patients were treated with TKP. Complications of these TKPs are described and all cases were compared with age and gender matched primary-TKP-controls. WOMAC and VAS pain scores were assessed before and after TKP treatment.Results: The mean survival time of the five KJD before TKP was 61 ± 15 months (range 45-84 months). No peri-operative complications were registered and none of the patients suffered from an infection post-TKP. There were no differences between baseline characteristics of patients with primary TKP compared to those with TKP after KJD except for a higher VAS pain score (p<0.02) for primary TKP. Mean follow-up after TKP was 21 ± 12 months (range 9-39 months). Efficacy after TKP was similar for patients with primary TKP compared to those with TKP after KJD.Conclusion: Based on the first five cases it appears safe to treat patients several years after KJD with a TKP. There is no indication these patients have a higher infection risk and post-operative outcome is comparable with primary TKP.