Knee arthrodesis with a long intramedullary nail as limb salvage for complex periprosthetic infections

  • Nima Razii
  • Ammar M. I. Abbas
  • Rahul Kakar
  • Sanjeev Agarwal
  • Rhidian Morgan-Jones
Original Article • KNEE - ARTHROPLASTY

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.

Keywords

Knee arthroplasty Revision Periprosthetic infection Arthrodesis Intramedullary nail Limb salvage 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no financial disclosures or conflicts of interest to declare.

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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Nima Razii
    • 1
  • Ammar M. I. Abbas
    • 1
    • 2
  • Rahul Kakar
    • 1
  • Sanjeev Agarwal
    • 1
  • Rhidian Morgan-Jones
    • 1
  1. 1.Cardiff and Vale Orthopaedic CentreUniversity Hospital LlandoughCardiffUK
  2. 2.Department of Trauma and OrthopaedicsWishaw General HospitalLanarkshireUK

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