Nima Razii1, Ammar M I Abbas2,3, Rahul Kakar2, Sanjeev Agarwal2, Rhidian Morgan-Jones2. 1. Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK. nima.razii@doctors.org.uk. 2. Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK. 3. Department of Trauma and Orthopaedics, Wishaw General Hospital, Lanarkshire, UK.
Abstract
BACKGROUND: Periprosthetic infection following total knee arthroplasty is a devastating complication, which is not always satisfactorily resolved by revision surgery. Arthrodesis is a salvage alternative to above-knee amputation or permanent resection arthroplasty. Fixation options include internal compression plating, external fixation, and intramedullary nails. METHODS: We retrospectively reviewed twelve consecutive cases (9 males, 3 females; mean age, 67 years) of knee arthrodesis with a long intramedullary nail, performed at a single institution between 2003 and 2014. Desired outcomes were the ability to mobilize without pain, solid radiographic fusion, and the eradication of infection. RESULTS: Mean follow-up was 48.5 months (range, 9-120 months). Eleven patients (92 %) demonstrated stable fusion, ten patients (83 %) were ambulatory without pain, and ten patients (83 %) remained without infection at most recent follow-up. Eight patients (67 %) achieved union at an average of 12 months; three required repeat procedures, achieving union at an average of 9 months. There was a significant difference (P < 0.01) between the numbers of previous operations amongst the eight patients who initially achieved union (mean, 3.25) and three who subsequently required repeat procedures (mean, 8.33). CONCLUSIONS: In contrast to similar studies, we performed a single-stage exchange where possible, while comparable ambulatory and fusion rates were observed. Numerous previous attempts at revision arthroplasty, co-morbidities, and infections with highly resistant organisms have been associated with further complications. Although technically challenging, knee arthrodesis with a long intramedullary nail offers an acceptable limb salvage procedure for carefully selected patients with complex periprosthetic infections.
BACKGROUND: Periprosthetic infection following total knee arthroplasty is a devastating complication, which is not always satisfactorily resolved by revision surgery. Arthrodesis is a salvage alternative to above-knee amputation or permanent resection arthroplasty. Fixation options include internal compression plating, external fixation, and intramedullary nails. METHODS: We retrospectively reviewed twelve consecutive cases (9 males, 3 females; mean age, 67 years) of knee arthrodesis with a long intramedullary nail, performed at a single institution between 2003 and 2014. Desired outcomes were the ability to mobilize without pain, solid radiographic fusion, and the eradication of infection. RESULTS: Mean follow-up was 48.5 months (range, 9-120 months). Eleven patients (92 %) demonstrated stable fusion, ten patients (83 %) were ambulatory without pain, and ten patients (83 %) remained without infection at most recent follow-up. Eight patients (67 %) achieved union at an average of 12 months; three required repeat procedures, achieving union at an average of 9 months. There was a significant difference (P < 0.01) between the numbers of previous operations amongst the eight patients who initially achieved union (mean, 3.25) and three who subsequently required repeat procedures (mean, 8.33). CONCLUSIONS: In contrast to similar studies, we performed a single-stage exchange where possible, while comparable ambulatory and fusion rates were observed. Numerous previous attempts at revision arthroplasty, co-morbidities, and infections with highly resistant organisms have been associated with further complications. Although technically challenging, knee arthrodesis with a long intramedullary nail offers an acceptable limb salvage procedure for carefully selected patients with complex periprosthetic infections.
Authors: Kevin J Bozic; Sridar Durbhakula; Daniel J Berry; James M Naessens; Karen Rappaport; Miriam Cisternas; Khaled J Saleh; Harry E Rubash Journal: J Arthroplasty Date: 2005-10 Impact factor: 4.757
Authors: James H MacDonald; Sanjeev Agarwal; Matthew P Lorei; Norman A Johanson; Andrew A Freiberg Journal: J Am Acad Orthop Surg Date: 2006-03 Impact factor: 3.020
Authors: Antonia F Chen; Nicholas C Kinback; Alma E Heyl; Edward J McClain; Brian A Klatt Journal: Clin Orthop Relat Res Date: 2012-10 Impact factor: 4.176
Authors: Arnold J Suda; Xaver Brachtendorf; Marco Tinelli; Raed Wagokh; Ghaith Abou-Nouar; Oliver E Bischel Journal: Int Orthop Date: 2021-04-23 Impact factor: 3.075