Septic single-stage knee arthrodesis after failed total knee arthroplasty using a cemented coupled nail

Abstract

Knee arthrodesis is a potential salvage procedure for limb preservation after failure of total knee arthroplasty (TKA) due to infection. In this study, we evaluated the outcome of single-stage knee arthrodesis using an intramedullary cemented coupled nail without bone-on-bone fusion after failed and infected TKA with extensor mechanism deficiency. Between 2002 and 2012, 27 patients (ten female, 17 male; mean age 68.8 years; 52 to 87) were treated with septic single-stage exchange. Mean follow-up duration was 67.1months (24 to 143, n = 27) (minimum follow-up 24 months) and for patients with a minimum follow-up of five years 104.9 (65 to 143,; n = 13). A subjective patient evaluation (Short Form (SF)-36) was obtained, in addition to the Visual Analogue Scale (VAS). The mean VAS score was 1.44 (SD 1.48). At final follow-up, four patients had recurrent infections after arthrodesis (14.8%). Of these, three patients were treated with a one-stage arthrodesis nail exchange; one of the three patients had an aseptic loosening with a third single-stage exchange, and one patient underwent knee amputation for uncontrolled sepsis at 108 months. All patients, including the amputee, indicated that they would choose arthrodesis again. Data indicate that a single-stage knee arthrodesis offers an acceptable salvage procedure after failed and infected TKA.

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.

“…Friedrich et al [ 23 ] set a minus two centimeters to allow walking without circumduction of the leg after IM nailing. The mean LLD following IM nailing in the present analysis was about 2 cm and was significantly smaller than that recorded after EF arthrodesis, confirming previous positive results of modular nail without bone fusion [ 5 ]. No significant differences in the quality of life and severity of pain between the two surgical strategies were detected in this study, but these findings should be interpreted with caution in the context of the limited available data.…”

“…After detailed assessment, we excluded 48 references. The remaining 26 articles [ 5 , 10 , 12 , 13 , 16 – 37 ] were included in the meta-analysis. Two of these [ 10 , 22 ] were retrospective studies comparing outcomes of nail and EF arthrodesis.…”

“…With the numbers available, no differences in fusion rate emerged between long and short periarticular nails. Several recent studies reporting results of modular IM implants disregarded bony union as an endpoint since it was not considered essential to obtain successful outcome [ 5 , 10 , 12 , 23 , 26 , 29 , 33 ]. Conversely, bony union is of outmost importance for EF arthrodesis.…”

“…Once any measures to salvage a functional TKA through multiple revision procedures have been exhausted, knee arthrodesis or the above-knee amputation represent the only options to eradicate the infection. Amputation should only be performed in conditions of severe and irreversible damage of the bone and soft-tissues [ 2 , 5 ] because of its unsatisfactory functional results [ 6 , 7 ]. Conversely, knee arthrodesis can provide acceptable quality of life and functionality of the knee when there is sufficient residual bone stock [ 8 ].…”

A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee Arthroplasty

“…N. Hawi et al studied artificial fusion by Link nail and antibioticloaded cement in 27 patients [5]. They had 4 cases of reinfection that one of them underwent knee amputation.…”