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Distraction arthrodesis with intramedullary nail and mixed bone grafting after failed infected total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine the success rate of the distraction arthrodesis, which was attempted to maintain the limb length during arthrodesis using an intramedullary nail and mixed bone grafting, in terms of the eradication of infection, solid union, and functional outcome. The hypothesis was that distraction arthrodesis would be successful in union and elimination of infection with minimal limb shortening and a satisfactory functional outcome despite large bone defects.

Methods

Eight patients were managed by arthrodesis using a Huckstep intramedullary nail and massive corticocancellous bone chip grafts from autologous iliac bone and deep-frozen femoral head allografts were included in the study. The mean age of the patients was 65.5 ± 7.1 years, and the follow-up duration was 52.1 ± 21.3 months. A mean of 5.3 ± 1.3 surgical procedures had been performed before arthrodesis. The mean longest and shortest distances of the bone defect were 58.6 ± 10.3 and 34.6 ± 7.0 mm, respectively.

Results

Radiological union was obtained in all cases at a mean of 9.9 ± 1.9 months. The mean postoperative limb shortening was 11.0 ± 7.3 mm when compared to the contralateral knee. The mean Knee Society score was 59.9 ± 9.2, and the function score was 38.8 ± 13.3. No additional procedures were required for any of the patients.

Conclusion

Distraction arthrodesis of infected knees following total knee arthroplasty demonstrated union and eradication of infection in all patients and a large tibiofemoral gap due to the severe bone defect could be managed with massive bone chip grafts. This method of arthrodesis would be a reliable and an effective method for failed total knee arthroplasty when two-staged reimplantation fails or is not attainable.

Level of Evidence

Study of case series with no comparison group, Level IV.

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Acknowledgments

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea. (A100451).

Conflict of Interest

The all authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul Nation University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Sahnghoon Lee, Jak Jang, Sang Cheol Seong & Myung Chul Lee

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  1. Sahnghoon Lee
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  2. Jak Jang
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Correspondence to Myung Chul Lee.

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Lee, S., Jang, J., Seong, S.C. et al. Distraction arthrodesis with intramedullary nail and mixed bone grafting after failed infected total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20, 346–355 (2012). https://doi.org/10.1007/s00167-011-1724-5

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