A comparison of outcomes for above-knee-amputation and arthrodesis for the chronically infected total knee arthroplasty: a systematic review.

INTRODUCTION: Several strategies have been shown to have some efficacy in the chronically infected total knee arthroplasty (TKA): chronic antibiotic suppression, a second two-stage revision, arthrodesis, and above-the-knee amputation (AKA). We conducted a systematic review to determine the efficacy of these treatments in patients who had previously received a two-stage revision. METHODS: A systematic review of the literature was performed which investigated PubMed, Embase, Scopus, and Web of Science Databases. Chronic infection was defined as a persistent infection of a TKA after a previous two-stage revision. Studies were independently evaluated by two reviewers. Quality appraisal was performed using MINORS Criteria. RESULTS: 14 studies were included for the final review. For chronically infected TKA, a second two-stage revision was often sufficient to control infection. If revision failed, the most common next procedure was either a repeat revision or AKA. AKA patients had less pain and higher quality of life scores compared to arthrodesis, but a higher five-year mortality rate. DISCUSSION AND CONCLUSION: Chronic infection in TKA offers a multitude of challenges for orthopedic surgeons. We found that arthrodesis and AKA were not significantly different in rates of infection eradication or quality of life. We recommend clinicians to actively discuss options with patients to find a procedure most suitable for them.

Increased Rate of Fracture Injuries Associated With Alternative Modes of Transportation During COVID-19.

OBJECTIVE: COVID-19 disrupted public transit and led to increased reliance on alternative modes of transportation (AMTs) internationally. This study hypothesizes that public interest and fracture injuries associated with AMTs increased during COVID-19 in the United States. METHODS: Monthly Google search probabilities and the number of fracture injuries associated with bicycles, scooters, skateboards/longboards, rollerblades, electric bicycles, and electric micromobility vehicles were collected from January 2017 to December 2021. Wilcoxon signed-rank tests were used to assess differences in search probabilities and fracture injuries between 2021, 2020, and 2019. Linear regression was used to study the relationship between search probabilities and number of fracture injuries. RESULTS: For bicycles, skateboards/longboards, electric bicycles, and electric micromobility vehicles, search probabilities and fracture injuries were higher in 2021 and 2020 compared with 2019, except for bicycle fractures in 2021 (P < 0.05). For every AMT, except roller skates, search probability had an explanatory effect on fracture injuries (P < 0.001). CONCLUSION: Online interest in AMTs and associated fracture injuries increased during the COVID-19 pandemic. Excess fractures seem to be stabilizing as of December 2021, but online search volumes may be used to inform the allocation of orthopaedic trauma resources during future surges in COVID-19 and other epidemics.