Recurrent Implant-Associated Infection After Pancarpal Arthrodesis Resolved Following Simini Lavage at Second Revision
AniCura Tierklinik Haar GmbH · Right Pancarpal Arthrodesis · Multi-Stage Revision
Case Summary
An 8-year-old female castrated Altdeutscher Hutehund presented with instability and infection following pancarpal arthrodesis performed at a previous clinic. Over 14 months, the patient underwent four surgeries for revision arthrodesis, implant removal, and re-revision, complicated by recurrent Staphylococcus intermedius infection.
At the second revision surgery on 21/08/2020, Simini Protect Lavage was used during the procedure. Bacteriology was negative immediately post-surgery. Following final implant removal in January 2021 and a 14-day course of fluoroquinolone, no further signs of infection developed. The patient has been walking normally since and was confirmed well at the last follow-up in May 2024.
Clinical History
Prior Surgeries and Recurrent Infection
The patient had undergone pancarpal arthrodesis at a referring clinic, followed by implant removal at the same clinic. She was referred to AniCura Tierklinik Haar on 13/12/2019 with instability and active infection at the arthrodesis site. The clinical course prior to the second revision, during which Simini Protect Lavage was used, involved multiple surgical interventions and recurrent Staphylococcus intermedius infection.
| Date | Event |
|---|---|
| 13/12/2019 | Referred with instability and infection following pancarpal arthrodesis and implant removal at prior clinic. |
| 21/01/2020 | Surgery: spongiosa harvest from right humerus; first revision right pancarpal arthrodesis (FixIn system). |
| 03/04/2020 | Fistula and active infection identified at revision site. |
| 17/04/2020 | Culture and sensitivity: Staphylococcus intermedius confirmed. |
| 25/05/2020 | Surgery: implant removal (infection and instability after first revision), cast bandage applied. |
| 29/07/2020 | Deep surgical culture: Staphylococcus intermedius confirmed. Six weeks of targeted antibiotic treatment commenced per antibiogram. |
| 21/08/2020 | SiminiSurgery: second revision right pancarpal arthrodesis (LCP plate). Simini Protect Lavage applied during procedure. Bacteriology negative post-surgery. |
Fig. 1 — Right carpal region showing skin changes and evidence of chronic infection at the pancarpal arthrodesis site. Fistulation and perilesional inflammation consistent with recurrent implant-associated Staphylococcus intermedius infection.
Surgical Protocol
Second Revision Surgery — 21/08/2020
Following confirmed recurrent Staphylococcus intermedius infection, a second revision arthrodesis was performed using an LCP plate with combination cortical and locking screws, with cancellous bone graft. Simini Protect Lavage was applied intraoperatively.
| Step | Description |
|---|---|
| 01 | General anaesthesia induced. Right forelimb prepared and draped aseptically. |
| 02 | Previous fixation remnants and infected tissue debrided. |
| 03 | Bone ends prepared for arthrodesis. LCP plate selected for fixation. |
| 04 | SiminiSimini Protect Lavage applied intraoperatively across the revision site. |
| 05 | LCP plate secured with combination cortical and locking screws. Cancellous bone graft placed. |
| 06 | Routine layered closure performed. |
| 07 | Post-operative bacteriology samples collected — result negative. |
Fig. 2 — Pre-operative lateral radiograph, right limb. Residual hardware and bony changes at the carpal arthrodesis site prior to second revision surgery.
Fig. 3 — Post-operative radiograph following second revision. LCP pancarpal arthrodesis plate secured with combination cortical and locking screws. Cancellous bone graft in situ.
This case involved recurrent Staphylococcus intermedius infection over 14 months, with multiple prior surgical interventions failing to resolve the infection. Simini Protect Lavage was applied during the second revision arthrodesis. Bacteriology was immediately negative post-surgery. The patient subsequently underwent final implant removal in January 2021 followed by a 14-day fluoroquinolone course. No further signs of infection developed, and the patient was confirmed well at the last follow-up in May 2024 — representing over three years without recurrence following the Simini-assisted revision.
Outcomes
Post-Simini Recovery and Long-Term Follow-Up
Bacteriology Negative Post-Surgery
Immediate post-operative bacteriology confirmed negative following the Simini-assisted second revision.
Final Implant Removal
Implant removed without signs of active infection. 14-day fluoroquinolone course completed. No further infection signs.
Long-Term Follow-Up
Patient confirmed walking normally. No signs of infection in over three years since last revision. Case considered resolved.
This case represents a single-surgeon experience at AniCura Tierklinik Haar GmbH. The chronology involves multiple surgical procedures; Simini was applied at the second revision surgery only.
Follow-Up Timeline
Post-Operative Course
Referral
Presented with instability and infection post-arthrodesis at prior clinic.
First Revision
Revision arthrodesis with FixIn system. Spongiosa harvest from right humerus.
Infection Confirmed
Fistula and active infection. S. intermedius confirmed on culture.
Implant Removal
Removed due to infection and instability. Cast bandage applied.
Second Revision + Simini
LCP plate with Simini Protect Lavage. Post-op bacteriology negative.
Final Implant Removal
Infection-free. 14-day fluoroquinolone course completed.
Long-Term Follow-Up
Walking normally. Infection-free for 3+ years.