Fusion rate of 89% after knee arthrodesis using an intramedullary nail: a mono-centric retrospective review of 48 cases

Abstract

Purpose Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate. Methods A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2™ Arthrodesis Nail, 6 OsteoBridge® Knee Arthrodesis and 27 Wichita® fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6–18 years). Results Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita® fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%). Conclusion Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita® fusion nail shows a tendency to better results compared to the two other nails. Level of evidence Case series, level IV

Early results of a novel modular knee arthrodesis implant after uncontrolled periprosthetic knee joint infection

“…The implantation of the modular knee arthrodesis led to a 6-point drop in the average VAS score at the final follow-up assessment. Luyet et al found a postoperative VAS score of 2.8 with a similar modular knee arthrodesis implant [20]. In another study with a modular intramedullary arthrodesis nail, the VAS scores were reduced from the preoperative mean of 7.9 to 2.8 at final follow-up [7].…”

“…Although there are no biomechanical studies that investigate the current implant the clinical outcomes were noninferior to the results of the aforementioned implants. Luyet et al reported a postoperative VAS score a 2.8 in their cohort of OIKA-treated with a late-complication rate of 50%[20]. Additionally, Iacono et al reported one intraoperative fracture in 22 patients with the insertion of the WLS nail…”

Knee Arthrodesis Surgical Technique

“…Complication rates have been reported upward of 80%. 3 Knee arthrodesis has been shown to result in approximately a 90% fusion rate, 4 although early results by Charnley and Lowe 5 reported only 2 failures in 171 cases of compression knee arthrodesis (98.8% success rate). Elimination of infection is of paramount importance.…”

Circular external fixation for knee fusion in complex indications

“…dual plating) is not advised, unless two-stage surgery is planned to eradicate the infection [ 7 , 8 ]. An intramedullary nail offers the advantage of early weight bearing and fast rehabilitation; however, in the presence of pre-existing infection, there is a high risk of spread and further morbidity [ 6 , 8 , 9 ]. Intramedullary nailing also has limited value when there is significant malalignment or limb shortening.…”