Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2023; 11(10): 2321-2328
Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2321
Treatment of periprosthetic knee infection and coexistent periprosthetic fracture: A case report and literature review
Lin-Jie Hao, Peng-Fei Wen, Yu-Min Zhang, Wei Song, Juan Chen, Tao Ma
Lin-Jie Hao, Peng-Fei Wen, Yu-Min Zhang, Wei Song, Juan Chen, Tao Ma, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710000, Shaanxi Province, China
Author contributions: Ma T and Zhang YM conceived and performed the surgery; Hao LJ assembled previous reported records and drafted the manuscript; Wen PF, Song W, and Chen J helped perform the surgery and revised the manuscript for important intellectual content; all authors have read and approved the final manuscript.
Supported by the General Cultivation Project of Xi'an Health Commission, No. 2021ms08.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this case report.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Ma, MD, Chief Doctor, Surgeon, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an 710000, Shaanxi Province, China. 171303186@qq.com
Received: December 15, 2022
Peer-review started: December 15, 2022
First decision: January 20, 2023
Revised: February 8, 2023
Accepted: March 6, 2023
Article in press: March 6, 2023
Published online: April 6, 2023
Processing time: 104 Days and 21.1 Hours
Abstract
BACKGROUND

Periprosthetic joint infection (PJI) and periprosthetic fracture (PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.

CASE SUMMARY

A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final follow-up 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion (104º) and Hospital for Special Surgery knee score (82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.

CONCLUSION

Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.

Keywords: Knee arthroplasty; Periprosthetic joint infection; Periprosthetic fractures; Complications; Surgical revision; Case report

Core Tip: Periprosthetic joint infection (PJI) and periprosthetic fracture (PPF) are among the most serious complications of knee arthroplasty. A two-stage revision surgery should be progressively performed in the treatment of PJI and coexistent PPF with bone loss. In the first-stage operation, a T-shaped cement spacer made from a rectangular vancomycin laden cement block and a cement coated plate was used after debridement. In the second-stage operation, the combination of cemented prosthesis and freeze-dried cortical allogenic splints were used for knee revision and fixation of PPF. Our approach offers an option for successful treatment of PJI and PPF.