Application of structural allogenous bone graft in two-stage exchange arthroplasty for knee periprosthetic joint infection: a case control study

Chieh An Chuang; Sheng-Hsun Lee; Chih-Hsiang Chang; Chih-Chien Hu; Hsin-Nung Shih; Steve W N Ueng; Yuhan Chang

doi:10.1186/s12891-022-05228-6

Application of structural allogenous bone graft in two-stage exchange arthroplasty for knee periprosthetic joint infection: a case control study

BMC Musculoskelet Disord. 2022 Apr 5;23(1):325. doi: 10.1186/s12891-022-05228-6.

Authors

Chieh An Chuang¹, Sheng-Hsun Lee^{1

2}, Chih-Hsiang Chang^{1

2}, Chih-Chien Hu^{1

2}, Hsin-Nung Shih^{1

2

3}, Steve W N Ueng^{1

2

3}, Yuhan Chang^{4

5

6}

Affiliations

¹ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan.
² Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan.
³ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St., Kweishan, Taoyuan, Linko, Taiwan. yhchang@cloud.cgmh.org.tw.
⁵ Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan. yhchang@cloud.cgmh.org.tw.
⁶ College of Medicine, Chang Gung University, Taoyuan, Taiwan. yhchang@cloud.cgmh.org.tw.

Abstract

Background: Knee prosthetic joint infection (PJI) is a common but devastating complication after knee arthroplasty. The revision surgeries for knee PJI may become more challenging when it is associated with large bone defects. The application of structural bone allograft in knee revision surgeries with large bone defects is not a new technique. However, there is a lack of literature reporting its efficacy in PJI cases. This study aimed to investigate the outcome of structural fresh frozen allogenous bone grafts in treating patients in knee PJI with large bone defects.

Methods: We performed a retrospective cohort analysis of knee PJI cases treated with two-stage exchange arthroplasty at our institution from 2010 to 2016. 12 patients with structural allogenous bone graft reconstructions were identified as the study group. 24 patients without structural allograft reconstructions matched with the study group by age, gender, and Charlson comorbidity index were enrolled as the control group. The functional outcome of the study group was evaluated with the Knee Society Score (KSS). Treatment success was assessed according to the Delphi-based consensus definition. The infection relapse rate and implant survivorship were compared between groups.

Results: Revision knees with structural allograft presented excellent improvement in the KSS (33.1 to 75.4). There was no significant difference between infection relapse-free survival rate and prosthesis survival rate in the two groups. The 8-year prosthesis survival rate was 90.9% in the study group and 91% in the control group (p = 0.913). The 8-year infection relapse-free survival rate was 80 and 83.3% in the study group and control group, respectively (p = 0.377).

Conclusion: The structural fresh frozen allogenous bone graft provided an effective way for bone defect reconstruction in knee PJI with an accountable survival rate. Meanwhile, using structural allografts did not increase the relapse rate of infection.

Keywords: Bone defect; Periprosthetic joint infection; Revision knee arthroplasty; Structural allogenous bone graft.

MeSH terms

Arthroplasty, Replacement, Knee* / adverse effects
Arthroplasty, Replacement, Knee* / methods
Case-Control Studies
Humans
Knee Joint / diagnostic imaging
Knee Joint / surgery
Knee Prosthesis* / adverse effects
Prosthesis-Related Infections* / etiology
Prosthesis-Related Infections* / surgery
Reoperation / methods
Retrospective Studies
Treatment Outcome