Knee Arthrodesis in the Treatment of Failed Total Knee Replacement

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

“…Articular tuberculosis, sepsis, and poliomyelitis-induced instability were the primary indications for knee arthrodesis in the late 1800s and early 1900s; the most common indication today is failed, unsalvageable TKA [7,45]. The introduction of effective adjuvant treatments for bone Fig.…”

“…The failure rate of these devices is much higher than for conventional total joint arthroplasty; therefore, managing their failures has created a new indication for segmental arthrodesis [18,49]. The biomechanical demands on these arthrodeses are substantial and consequently the reported failure rates are high [2,5,9,20,44,45,49]. We report the results of segmental arthrodesis with a modular, metallic implant system.…”

“…The earliest biologic arthrodeses were performed using external fixation systems, intramedullary devices, and hybrid methods with union rates from 38% to 100% and different complications [1,13,17,19,22,24,32,33,36,45,48]. Vascularized fibulae have been used to augment arthrodesis reconstructions of all types with overall excellent results [29,31,37,46].…”

“…Although success rates of 80% to 100% have been reported after primary, biologic arthrodesis in patients without prior TKA [9,14,19,30,31,37,44], the success rate of arthrodesis performed in patients with an infection at the site of a TKA has been reported to be much lower [8]. However better results in terms of complication rates have been reported using metal implants than biologic reconstruction [2,8,9,11,13,23,33,42,45,47].Whereas Gosheger et al reported no infections in three arthrodeses with the MUTARS 1 implant [16] and Bartlett et al reported one infection in 10 Stanmore implants [3], there were nine infections in our 31 patients. This finding might be because the mean followup for our series was substantially longer at 9.5 years compared with the other series and of our infections were late infections.…”

Intramedullary Arthrodesis of the Knee in the Treatment of Sepsis after TKR

“…Plating is less popular, as the suboptimal soft tissues of the multiply operated knee may compromise coverage of bulky hardware [14,15]. Intramedullary devices have become increasingly popular, yet there are few large series in the literature reporting results for this technique exclusively in the management of failed TKR due to sepsis [16][17][18][19][20].…”