Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series

Abstract

Bridging knee arthrodesis with an intramedullary nail is a valuable salvage procedure with acceptable clinical results. As recurring infection remains the most challenging complication, regular clinical and radiological follow-up examinations are necessary following implant-related knee arthrodesis to allow timely intervention in case of loosening.

Modern Techniques in Knee Arthrodesis

“…They found that the average operative time for the procedure lasted 141 minutes and the mean estimated blood loss was 753 mL, which was comparable to revision TKA. Over a mean follow-up period of 56.4 months, a 30% complication rate was noted (range of 11.4%-81.8% from past studies) (Table 1) and a 90% (9 of 10 patients) survivorship of the arthrodesis was recorded with no evidence of residual infection or prosthesis failure [12,22,28,29,33] . One out of the ten patients experienced a recurrent infection which fell in the range of persistent or recurrent infection rates (0-45.5%) seen in past studies [12,13,20,22,28,33] (Table 1).…”

“…They noted an average leg length discrepancy of 15 mm (+/-15 mm), 3 recurrent cases of infection, and 2 minor complications. The average SF-36 score for physical function was 21.8, an inferior score when compared to other arthrodesis procedures as well as TKA and transfemoral amputation [22] . Bartlett et al retrospectively analyzed 10 patients who underwent a custom-made cemented Stanmore (Stanmore Implants Worldwide, Middlesex, UK) arthrodesis procedure, 9 of 10 having undergone previous yet unsuccessful attempts to eradicate their knee infection.…”

“…Additionally for long IMNs, when compared to modular shorter nails, extraction, when needed, was proven to be easier, faster, and cause less bone damage, and did not require taking down the fusion site like in modular nails [22,23] . However, higher rates of persistent infection have been identified in this technique and other intramedullary procedures [4,18,20] .…”

“…Following insertion, the two nails are then joined using one of a number of interlocking mechanisms, depending on the specific manufacturer and type of nail used [25] . The advantages of this procedure include minimization of leg length discrepancy, the ability to immediately bear weight on the leg despite severe bone loss, avoidance of pin-track infections, and the use of multiple interlocking screws, which may enhance the vertical and rotational stability of the knee and ultimately improve fusion rate [13,14,20,22,[26][27][28] . Carrying out a knee arthrodesis, using a modular nail, is not a demanding procedure and in one study, which analyzed the effects of a Wichita Fusion Nail (Stryker Orthopedics, Mahwah, New Jersey, USA) there were no differences in fusion rates between surgeons who were performing the surgery for the first time and those who were more experienced [29] .…”

Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results

“…Different techniques for knee arthrodesis have been reported, including plate and screw osteosynthesis, external fixation and intramedullary nailing, the latter two being the most often preferred in the presence of bone infection [10,12,13,15,[18][19][20][21]. Whereas the proposed techniques do achieve bone fusion and infection control in the majority of cases, residual limb-length discrepancy and possible nonunion are the primary limits of knee arthrodesis following septic TKA.…”