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Background: Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. Material and Methods: A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. Results: The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. Conclusions: This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany. [ABSTRACT FROM AUTHOR]

Introduction: We present a detailed procedure for the robotic-assisted plate osteosynthesis of an anterior acetabular fracture. The purpose of this work was to describe a robotic-assisted minimally invasive technique as a possible method for reducing complications, pain, and hospitalization. Another goal was to present technical recommendations and to assess potential pitfalls and problems of the new surgical approach. Methods: Surgery was performed in an interdisciplinary setting by an experienced orthopedic surgeon and a urologist. The DaVinci System with standard instruments was used. Reduction was achieved through indirect traction of a pin that was introduced into the femoral neck and direct manipulation via the plate. The plate position and fixation were achieved through 7 additional minimally invasive incisions. Results: The technique has multiple advantages, such as no detachment of the rectus abdominal muscle, a small skin incision, and minimal blood loss. Furthermore, this approach might lower the incidence of hernia formation, infection, and postoperative pain. Discussion: We see the presented technique as a demanding yet progressive and innovative surgical method for treating acetabular fractures with indications for anterior plate fixation. Trial registration: The study was approved by the local institutional review board (Nr. 248/18). [ABSTRACT FROM AUTHOR]

Background: While inter-hospital transfers for patients who have suffered major trauma have been well investigated, patient flows for other injured patients, or cases with orthopedic complications, are rarely described. This study aims to analyze the affected collective and to show possible reasons, patterns, and pitfalls to optimize the process in future. Materials and methods: In a prospective cohort study, all consecutive transfers to a Level I trauma center in Germany were documented and assessed. Patients suffering a major trauma were excluded. Data on the primary treating hospital, patient characteristics, and differences between emergency and elective surgery were analyzed. Results: A total of 227 patients were included; 162 were injured, while 65 had suffered a complication after elective orthopedic surgery or had a complex orthopedic pathology. The most common diagnoses leading to transfer were pathologies of the extremities (n = 62), pathologies of the spine (n = 50), and infections (n = 18). The main reasons stated by the transferring hospitals were a lack of expertise (137 cases) and a lack of capacity (43 cases). There was a significantly higher rate of transfers due to trauma (n = 162) than for orthopedic patients (n = 65), p < 0.0001. Conclusion: There is currently no structured procedure or algorithm for transferring patients in orthopedics and trauma surgery. [ABSTRACT FROM AUTHOR]

A prospective, feasibility, randomised study was performed to compare intramedullary versus extramedullary fixation of unstable pertrochanteric fractures and to assess the feasibility of including patients with dementia. From July 2016 to November 2017, 60 consecutive patients with an unstable pertrochanteric (OTA/AO 31-A2) fracture were randomized to either receive a short cephalomedullary nail (Endovis EBA2, Citieffe) or a dynamic hip screw (DHS, Zimmer Biomet). Primary feasibility measures included randomisation, recruitment, and retention rates. Secondary outcomes included peri-operative parameters, patient-reported outcomes and radiographic outcomes. Patients were followed-up at two, four, and twelve weeks. There was no difference in the randomisation rate between patients with and without cognitive impairment. Significantly more patients without cognitive impairment attended the 12-week follow-up. The overall recruitment rate was 0.9 patients per week. Patients treated with the nail had less pain at 2 weeks and less neck collapse, medialisation, and leg shortening at all time points. The rest of secondary outcomes were similar. Patients with dementia can successfully be enrolled in a randomised trial on hip fractures. Patients treated with the Endovis nail had lower levels of pain at two weeks and better radiographic outcomes. [ABSTRACT FROM AUTHOR]

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Introduction: Acetabular defect recognition and classification remains a challenging field of practice for orthopedic surgeons. Recently, the Acetabular Defect Classification (ADC) has been introduced to provide a reliable, reproducible and intuitive classification system. In order to improve ease of use and efficiency of the ADC, a browser-based application has been created. We hypothesized that the ADC application can improve rating performance of non-specialists (medical students) to achieve good inter- and intra-rater agreement and will compare favorable to the results of specialists (experienced surgeons) without the help of the application. Materials and methods: The ADC is based on the integrity of the acetabular rim and the supporting structures. It consists of four main types of defects ascending in severity. These defects are further subdivided in A–C, narrowing down defect location. 80 randomized radiographs were graded according to ADC by three non-specialists (medical students) with help of the ADC application and by three specialists (orthopedic surgeons) without help of the application to evaluate the difference in inter-rater agreement between groups. To account for intra-rater agreement, the rating process was repeated after a reasonable wash-out period. Results: Inter-rater and intra-rater agreement within the non-specialist group rated lower when compared to the specialist group while still falling into the good agreement range. The student group presented with k values of 0.61 for inter-rater agreement and 0.68 for intra-rater agreement, while the surgeon group displayed k values of 0.72 for inter-rater agreement and 0.83 for intra-rater agreement. Conclusion: The app-guided assessment of acetabular defects offers a promising innovative approach to simplify complex situations. It makes the challenging field of acetabular revision arthroplasty more approachable especially for less experienced surgeons and offers insight and guidance in the planning stage as well as intra-operative setting. [ABSTRACT FROM AUTHOR]

Introduction: The complex field of femoral defects in revision hip arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment. To address this issue, the femoral defect classification (FDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline. Materials and methods: The FDC is based on the integrity of the main femoral segments which determine function and structural support. It focuses on the femoral neck, the metaphysis consisting of the greater and lesser trochanter, and the femoral diaphysis. The four main categories determine the location of the defect while subcategories a, b and c are being used to classify the extent of damage in each location. In total, 218 preoperative radiographs were retrospectively graded according to FDC and compared to intraoperatively encountered bone defects. To account for inter-rater and intra-rater agreement, 5 different observers evaluated 80 randomized cases at different points in time. Results: A Cohens kappa of 0.832 ± 0.028 could be evaluated, accounting for excellent agreement between preoperative radiographs and intraoperative findings. To account for inter-rater reliability, 80 patients have been evaluated by 5 different observers. Testing for inter-rater reliability, a Fleiss Kappa of 0.688 could be evaluated falling into the good agreement range. When testing for intra-rater reliability, Cohens Kappa of each of the 5 raters has been analyzed and the mean was evaluated at 0.856 accounting for excellent agreement. Conclusion: The FDC is a reliable and reproducible classification system. It combines intuitive use and structured design and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm has been created according to current literature and expert opinion. Due to the combination of the FDC with the recently introduced Acetabular Defect Classification (ADC) a structured approach to the entire field of hip revision arthroplasty is now available. [ABSTRACT FROM AUTHOR]

Background: In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time. Patients and Materials: A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed. Results: A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009–2017 (65% less; p = 0.003) than in 2000–2008. Conclusion: Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to describe and analyse the most severe casualties from the flash flood and mudslides occurring on 14 July 2021 in Germany, focusing on patients who were treated in the closest and largest level I trauma centre in the region the disaster occurred. Methods: A single-centre retrospective study design was employed, and all patients treated because of the flooding and mudslides who needed inpatient treatment were documented. Data on each patient's demographic characteristics, type of injury, number of surgeries, duration of hospitalisation, operation time, revision rate, injury severity score (ISS), and complications were collected. The primary outcome measure was status at discharge. Results: Within the first week after the flood, a total of 63 patients were documented. Forty-one patients were treated on an outpatient basis in the emergency unit, and 22 patients were hospitalised. Of those hospitalised, 15 patients needed surgical treatment in the operation theatre. The most common injuries were fractures of the lower extremity (n = 7) and soft tissue wounds (n = 4). Overall, 20 surgeries were performed; the mean hospital stay was 7.2 ± 6.4 days, and the mean ISS was 5.7 ± 2.7. Conclusion: The July 2021 flood disaster was one of the largest in German history. The included patients showed complex injuries of various types. Because of the effects of climate change, orthopaedic surgeons might face higher numbers of casualties affected by natural disasters. Learning more about the management and profile of these injuries can become a future challenge for orthopaedic and trauma surgeons. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sacroiliac joint (SIJ) painful dysfunction is a common source of low back pain (LBP). Several surgical treatment options for SIJ fusion were described. A promising treatment option with demonstrated clinical improvement is the minimally-invasive SIJ fusion. OBJECTIVE: The aim of this case study was to document the effectiveness and safety of the new SIJ system (Torpedo ®) over a period of 6 months after the minimally invasive implantation. METHODS: Patients with failed conservative treatment of painful SIJ dysfunction were enrolled successively in two centers. The Diagnosis was made by positive response to SIJ-injection with local anesthetic and at least by two positive SIJ provocation tests. The Torpedo ® Implant system was used for the implantation. This workpiece made of titanium alloy is characterized by a helical profile geometry (CST: chronical spinal turn) with a hydrophilic surface. The evaluated endpoints LBP and grade of disability were assessed using a 0–10 numerical rating scale (NRS), and Oswestry Disability Index (ODI) preoperatively and at one, three and six months postoperatively. RESULTS: 15 patients (10 female, 5 male; mean age 59 ± 13 years) were operated on one after the other. The pain intensity decreased in all 15 patients. After 6 months, a decrease in the median values of 70% (quartiles 1–3: 65–79%) was calculated. The median values of the Oswestry Disability Index after 6 months were 62% (quartiles 1–3: 53–67) lower than before the operation. Before surgery, 13 patients (87%) were taking opioids for pain management. Six months after the operation, opioids were only needed by 3 patients (20%). Implant malpositioning was not detected on plain radiograph. No surgical site infections or perioperative complications occurred. CONCLUSIONS: The clinical improvement in early follow up and the absence of surgery related complications demonstrate a high grade of device-related safety and effectiveness of the treatment with a novel minimally-invasive SIJ fusion system. [ABSTRACT FROM AUTHOR]

Background: Surgery for humeral shaft fractures is associated with a high risk of iatrogenic radial nerve palsy (RNP). Plausible causes are difficult anatomical conditions and variants.Methods: We performed a cadaveric study with 23 specimens (13 female and 10 male Caucasian donors) to assess the course and anatomy of the radial nerve (RN) with its branches alongside the humeral shaft. The accuracy of identification of the RN in the surgical field was analyzed by measuring the location, course, diameter, and form of each nerve and vessel of interest.Results: The RN is not a single structure running alongside the humeral shaft; at least 4 parallel structures crossed the dorsal humerus in all subjects. The RN was accompanied by 2 vessels and at least 1 other nerve, which we named the musculocutaneous branch (MCB). With an oval profile and an average diameter of 3.1 mm (range, 2.6 to 3.8 mm), the MCB was thinner but, in some cases, close to the average diameter of 4.7 mm (range, 4.0 to 5.2 mm) of the RN, which had a round profile. Both accompanying vessels had similar diameters: 3.5 mm (range, 2.6 to 4.2 mm) for the radial collateral artery and 4.0 mm (range, 2.9 to 4.4 mm) for the medial collateral artery. In 20 (87%) of the cases, the RN ran proximal to and in 3 (13%) of the cases, distal to the MCB. Furthermore, a distal safe zone of at least 110 mm (range, 110 to 160 mm) was found, measured from the radial (lateral) epicondyle proximally.Conclusions: The RN does not cross the dorsal humerus alone, as often stated in anatomical textbooks, but runs parallel to vessels and at least 1 nerve branch with a similar appearance. Thus, for reliable preservation of the RN, we recommend identification and protection of all crossing structures in posterior humeral surgeries 110 mm proximal to the radial epicondyle. [ABSTRACT FROM AUTHOR]

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Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To evaluate the comparative effectiveness and safety of anterior cervical corpectomy with fusion (ACCF), laminoplasty (LP), and laminectomy and instrumented fusion (LF) in the treatment of ossification of the posterior longitudinal ligament (OPLL). Embase, Pubmed, and Cochrane library were searched from their date of inception to June 13, 2020. Relevant randomized controlled trials (RCTs) and cohort studies comparing different procedures among ACCF, LP, and LF were identified, data were extracted to perform a network meta-analysis (NMA). The outcomes were the Japanese Orthopedic Association (JOA) score and complications. We deemed 14 trials eligible, including 877 patients. In NMA, ACCF showed a significant improvement of JOA score compared with LP [MD= −0.89, 95% CI (–1.73, −0.18)], but no significant difference was found when compared LF with ACCF or LP. No significant differences in complications were found when compared LF with LP or ACCF, while ACCF showed significantly higher in complications than LP [OR = 1.99, 95% CI (1.10, 3.35)]. The surface under the cumulative ranking curves (SUCRA) showed that the rank of JOA score improvement is as follows: ACCF (82.5%), LF (79.5%), and LP (2.3%). And the rank of complication rate is as follows: LF (65.8%), ACCF (68.4%), and LP (2.1%). The biggest limitation was that none of the included studies were RCTs. Despite the higher probability of complications than LP, ACCF was the more recommended procedure for its highest ranking spectrums of JOA score improvement to treat the OPLL. [ABSTRACT FROM AUTHOR]

Background: Cervical spine injuries (CSI) are rare in trauma patients, at about 9.2–16.5/100,000 inhabitants in Scandinavia and Canada, and the annual incidence of CSI surgeries in Norway is around 3.0/100,000 inhabitants. However, despite their rarity, the incidence of CSI has increased, thereby assuming an increasing need for surgery. Outside of Scandinavia, no data about the incidence of CSI and subsequent surgeries exist. Therefore, this study aimed to analyse CSI epidemiology and surgery in a German city with a Level I trauma centre both to understand the injury and improve needs–based planning. Methods: This retrospective, monocentre study included all patients who presented with CSI from 2012–2017 at a university hospital with a Level I trauma centre in a major German city and had permanent residency within the city. Based on the assumption that the patients represented all CSI injuries in the city, as they were treated at the only available Level I trauma centre, the annual incidence of surgeries and neurologic deficits due to CSI were calculated. Results: A total of 465 patients with 609 CSI were identified. Of these patients, 61 both received surgery and resided in the city (mean age, 68.1 ± 18.3 years; 26 female, 35 male). The incidence of CSI surgeries was calculated as 3.24/100,000 person years (1.75/100,000 in the upper and 1.54/100,000 in the subaxial cervical spine). Neurologic deficits occurred in 0.64/100,000 person years. The incidence of both surgeries and neurologic deficits showed no significant changes over the 6-year study period. Conclusions: Compared to Scandinavia, an increasing annual incidence for CSI surgeries and neurologic deficits were found. For long-term demand planning with adaptability to demographic changes, cross-regional studies including long-term follow-up are necessary. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the comparative effectiveness and safety of open-door laminoplasty (OLP), French-door laminoplasty (FLP), laminectomy and fusion (LF), and laminectomy alone (LA) in treating multilevel degenerative cervical myelopathy (MDCM). Methods: Embase, PubMed, and Cochrane library were searched from their inception date to 7 January 2021. Randomized controlled trials and cohort studies comparing OLP, FLP, LF, and LA were identified to perform a network meta-analysis (NMA). Results: A total of 30 studies with 2671 patients were included. Our NMA results showed no significant difference between LF and OLP, but both are superior to LA and FLP in the comparison of JOA (Japanese Orthopaedic Association) score improvement. LF showed a most unsatisfactory outcome in postoperative range of motion (ROM) compared with LA or OLP or with FLP. For the complication outcome, no significant differences were found. The surface under the cumulative ranking curves (SUCRA) for JOA improvement was as follows: LF, OPL, LA, and FLP. For ROM reduction it was LA, OPL, FPL, and LF. For complications it was LF, LA, OLP, and FLP. Conclusions: Considering all the evaluated criteria, none of the procedures showed the best outcome with least complications and optimal efficacy. However, OLP can be most recommended because of its second-ranking spectra in both of JOA improvement and ROM reduction, also with an acceptable incidence of complications, with the third least. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects.Methods: The proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability.Results: We evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78.Conclusion: The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice. [ABSTRACT FROM AUTHOR]

Objective: Olecranon fractures are common injuries in patients of any age. The vast majority are treated with two operation techniques: a plate fixation (PF) or tension band wiring (TBW). The objective of this study is to compare the outcomes of surgically treated olecranon fractures with plate fixation or tension band wiring. We hypothesise that PF patients would show significantly inferior outcomes due to more complex injuries. Patients and methods: Between 2010 and 2017, a total of 108 patients were treated with plate fixation and or tension band wiring. Clinical data of 40 surgically treated olecranon fractures were collected and analysed. Clinical and functional evaluations were performed using Mayo-Score, DASH-Score, Weseley -Score and subject elbow value (SEV). Furthermore, complication rates, time to return to work and operation duration were documented. Results: The mean follow-up was 70.5 ± 45.6 months. Time of return to work was 6.5 ± 2.2 weeks in the TBW group and 10.9 ± 6,6 in the PF group (p = 0.372). The mean duration of surgery was 95.2 ± 47.0 min in the TBW group and 192.5 ± 113.0 min in the PF group (p = 0.001). In the TBW group, the mean hospitalisation period was 7.9 ± 10.1 days and 11.2 ± 9.8 days in the PF group. Revisions were required in 0.3 ± 0.6 of cases (0.2 ± 0.5 in TBE and 0.4 ± 0.7 in PF). The median DASH Score was 7.0 (3.6-13.7) in the TBW group and 12.1 (5.5-24.8) in the PF group (p = 0.948) Conclusion: Tension band wiring and plate fixation are both practical treatment options with mostly positive outcomes, even though high complication rates can occur. There were no significant differences in either group concerning functional outcome or time back to work. The duration of surgery was significantly higher in the PF group, whereas the incidence of metalwork-associated complications was higher in the TBW group. [ABSTRACT FROM AUTHOR]

Objective: External fixators are important for correcting length discrepancies and axis deformities in pediatric or trauma orthopedic surgery. Pin loosening is a common pitfall during therapy that can lead to pain, infection, and necessary revisions. This study aims to present clinical data using calcium titanate (CaTiO3) Schanz screws and to measure the fixation strength. Patients and methods: 22 titanate screws were used for external fixators in 4 pediatric patients. Therapy was initiated to lengthen or correct axial deformities after congenital abnormalities. The maximum tightening torque was measured during implantation, and the loosening torque was measured during explantation. In addition, screws of the same type were used in a cadaver study and compared with stainless steel and hydroxyapatite-coated screws. 12 screws of each type were inserted in four tibias, and the loosening and tightening torque was documented. Results: The fixation index in the in vivo measurement showed a significant increase between screw insertion and extraction in three of the four patients. The pins were in situ for 91 to 150 days, and the torque increased significantly (P = 0.0004) from insertion to extraction. The cadaveric study showed lower extraction torques than insertion torques, as expected in this setting. The calculated fixation index was significantly higher in the CaTiO3 group than in the other groups (P = 0.0208 vs. HA and P < 0.0001 vs. steel) and in the HA group vs. plain steel group (P = 0.0448). Conclusion: The calcium titanate screws showed favorable fixation strength compared to HA and stainless steel screws and should be considered in long-term therapy of external fixation. [ABSTRACT FROM AUTHOR]

Background: Failed total knee arthroplasty (TKA) with significant bone loss and compromised soft-tissues is challenging and the final results are often inferior to patient's expectation. The objective of this study was to present a comparison of outcomes in patients with failed infected TKA treated with two-stage revision TKA or knee arthrodesis and to assess clinical and functional results, implant survival and infection recurrence. The hypothesis was that an arthrodesis may result in beneficial effects on patients' outcome.Methods: Clinical data of 81 patients with periprosthetic joint infection (PJI) of the knee joint were collected and analyzed retrospectively. Between 2008 and 2014, a total of 36 patients had been treated within a two-stage exchange procedure and reimplantation of a modular intramedullary arthodesis nail and 45 patients with revision TKA. Patients were treated according to the same structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford knee score (OKS) and the visual analogue scale (VAS).Results: The mean follow-up was 32.9 ± 14.0 months. The rate of definitely free of infection at last follow-up in the arthrodesis group was 32 of 36 (88.9%) and 36 of 45 (80.0%) in the revision TKA group (p = 0.272). Mean VAS for pain in the arthrodesis group was 3.1 ± 1.4 compared to 3.2 ± 1.6 in the revision TKA group (p = 0.636). The OKS in the arthrodesis group was 38.7 ± 8.9 and 36.5 ± 8.9 (p = 0.246) in patients with revision TKA. Rate of revisions in the revision-TKA group was 2.8 ± 3.7 compared to 1.2 ± 2.4 in the arthrodesis group (p = 0.021).Conclusion: Treatment of PJI needs a distinct therapy with possible fallback strategies in case of failure. A knee arthrodesis is a limb salvage procedure that showed no significant benefits on the considered outcome factors compared to revision TKA but is associated with significantly lower revision rate. After exhausted treatment modalities, a knee arthrodesis should be considered as an option in selected patients.Level Of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]