Management of an Infected Nonunion of an Opening-Wedge High Tibial Osteotomy with 2-Stage Implantation of Rotating Hinge Knee Prosthesis

Abstract EN

Introduction.

High tibial osteotomy (HTO) is a frequent and effective treatment for unicompartmental gonarthritis.

Only a few articles are focused on the treatment of infected nonunion.

Patient and Method.

A 50-year-old obese patient was operated on by medial opening-wedge HTO.

She developed a painful nonunion treated by hardware removal, allograft, and plate fixation.

However, the nonunion persisted.

2 years later, cellulitis appeared with an abscess adjacent to the HTO plate.

Despite surgical debridement and antibiotics, septic knee arthritis occurred.

In a situation of infected nonunion and septic arthritis with chondrolysis, she was scheduled for a 2-stage total knee replacement (TKR).

The infected tibial articular block was first resected and replaced by a cement spacer.

After a short interval, the TKR was implanted.

After 2 years, the patient walked pain-free with good knee function.

Discussion.

In the literature, different efficient treatments exist for infected nonunion after HTO, but comprehensive studies are missing for a consensus treatment.

Current data are mostly based on case reports, since this pathology is quite rare.

Conclusion.

In a difficult situation of infected nonunion with septic knee arthritis, we performed a 2-stage knee prosthesis implantation.

This led to an early mobilization and fast recovery.