Mylène Jansen

Reduction of pin tract infections during KJD 157 8 Introduction Knee joint distraction (KJD) is a joint-preserving treatment for younger (<65 years) patients with severe knee osteoarthritis (OA). KJD aims to postpone total knee arthroplasty (TKA) and decrease the chance of a revision TKA later in life. 1 In KJD, the tibia and femur are placed at 5 mm distance for 6 weeks using an external fixation frame, fixed to the bones using 8 trans-cutaneous half pins. KJD has shown clinical benefit similar to TKA or osteotomy, as well as cartilage repair activity. 1–7 Effects can last for years, evaluated up to 9 years thus far. 8 Despite positive results that were observed in trials and regular care, the treatment can be a 6-week burden for patients when pin tract skin infections occur. 9 Pin tract infections are often seen in external fixation devices, and while a small number of studies have been published on how to prevent these infections, literature on this topic is limited. 10–14 Although in KJD the infections did not seem to have an influence on the patients’ clinical benefit, prevention could decrease the burden of this promising treatment. 9 Updating the wound care protocol (see: Methods) in between clinical trials revealed a positive effect in decreasing infections, reducing pin tract infections from 85% to 57% of patients. 9 However, further reduction was clearly desirable. 6 Therefore, the use of cadexomer iodine ointment was included in the KJD wound care protocol in regular care. The objective of this study was to evaluate whether using cadexomer iodine ointment reduced the number of patients with pin tract infections during KJD treatment. Methods Patients In the UMC Utrecht, knee OA patients with an indication for TKA, but younger than 65 years old, were offered KJD treatment in regular care. Specific considerations and criteria for KJD treatment in regular care have been described previously. 9 As standard procedure, all patients treated at the department of orthopedics are asked written consent for use of their anonymized data for future research purposes (protocol number 17-005). Ethical approval for this study was waived by the medical ethical review board of the University Medical Center Utrecht (protocol number 20-128/C). While KJD has been performed in regular care since 2014, a new dedicated distraction device (KneeReviver®; ArthroSave, Culemborg, The Netherlands) was introduced in November 2017, which was developed to better facilitate pin care and showed a significant reduction in pin tract infections. 15 To prevent bias, only patients who received the full KJD treatment with the KneeReviver® and had their frame removed before 2020 were included in the current cross-sectional study. All included patients gave written informed consent.