Table 1 Treatment algorithm for the implant
Conventional algorithm | Modified algorithm |
|---|---|
I) Stable hardware + bone not healed = retain hardware, antibiotics until healed, then hardware removal. II) Unstable hardware + bone not healed = remove hardware, antibiotics, temporary stabilization, spacer, and reconstruction when clean. III) Stable hardware + bone healed = remove hardware, debride with effort not to destabilize, control dead space, and antibiotics. IV) Stable hardware + bone not healed + systemic effects =remove hardware, temporary stabilize, spacer, antibiotics, and reconstruction when able, consider amputation if bad host. | 1. Stable hardware + bone not healed Cierny–Mader 1 type = remove hardware, temporary stabilize + antibiotic cement-coated (ACC) rods/Ilizarov technique, debridement, soft-tissue coverage, and reconstruction when clean. 2. Stable hardware + bone not healed Cierny–Mader 2 type = retain hardware, debridement, soft-tissue coverage, bone healed then hardware removal. 3. Stable hardware + bone not healed Cierny–Mader types 3 and 4 = remove hardware, temporary stabilize/Ilizarov technique, debridement, soft-tissue coverage, and reconstruction when clean. 4. Unstable hardware + bone not healed = remove hardware, temporary stabilize/Ilizarov technique, debridement, soft-tissue coverage, and reconstruction when clean. 5. Stable hardware + bone healed = remove hardware, debridement, soft-tissue coverage. |