Why the Ilizarov Ring Fixator Remains the Preferred Technique for Knee Arthrodesis in Complex Knee Conditions: A Case Series.

INTRODUCTION: In the present study, we describe clinical outcomes and observations of Ilizarov ring fixation used for a knee joint infection with pronounced joint destruction, soft tissue and bone involvement, which are serious diseases in which not only the joint but also the entire extremity is directly endangered. Salvage procedure in infected knees resulting from failed total knee arthroplasty, osteomyelitis, or septic arthritis. MATERIALS AND METHODS: We report a case series of four patients (two males and two females), including patients presenting with periarticular knee joint infection characterized by extensive soft-tissue involvement and significant osseous destruction, often complicated by chronic discharging sinuses and profound functional impairment. All patients underwent detailed clinical assessment and standard radiographic evaluation and comprehensive evaluations including C-reactive protein, erythrocyte sedimentation rate, limb-length discrepancy (LLD), knee injury and osteoarthritis outcome score, knee society score, Visual Analog Scale (VAS) score and Lysholm score. Intraoperative tissue samples were collected for post-operative microbiological analysis to identify the causative organisms and to guide targeted antimicrobial therapy, and an Ilizarov ring fixator was applied in compression mode. RESULTS: Union was achieved in all patients at both the distal femur and proximal tibia at a mean duration of 7 months (29.5 ± 4 weeks). The mean residual LLD was 2.1 ± 0.6 cm. Pain relief was substantial, with the VAS score decreasing from 7.5 ± 0.6 preoperatively to 2.0 ± 0.8 postoperatively. Similarly, the Lysholm score improved from 45.3 ± 2.5 preoperatively to 76.5 ± 4.3 postoperatively. CONCLUSION: The Ilizarov technique is an effective salvage procedure for complex knee joint pathologies. Its advantages include cost-effectiveness, avoidance of secondary surgical interventions, allowance for immediate weight-bearing, a high rate of arthrodesis, and a low incidence of complications.