Knee arthrodesis with Ilizarov's bone transport method for large infected periarticular defects: a report of three cases.

Large infected bone defects created by failed arthrodesis, tumoral resection, or posttrauma around the knee poses a great challenge to orthopedic surgeon. If prosthetic replacement has a high chance of failure; a knee arthrodesis can be considered for management. Three consecutive patients, treated between 2001 and 2003 for bone loss after tumor resection, failed knee arthrodesis and infected posttraumatic nonreconstructable knee joint were evaluated. After implant removal, debridement and irrigation, Ilizarov frame was applied for a knee arthrodesis with segmental bone transport through both femoral and tibial osteotomies. A second operation for the docking site refreshment was performed at the end of bone transport to enhance union. In all patients, a successful knee arthrodesis and acceptable alignment were achieved. Mean amount of bone transport was 173.3 mm (range, 110-220 mm). Average external fixator time was 10.1 month (range, 7.5-15 months) and average healing index was 18.5 d/cm (range, 10.2-23.6 d/cm). Equinovarus deformity occurred during treatment in two patients and was treated successfully with posteromedial release. Mean follow-up was 33.6 months after frame removal (range, 25-39 months). Neither had recurrence of pain and infection. We think knee arthrodesis with bone transport is an option to manage large infected bone defects that were not amenable for prosthetic replacement.