Abstract
Introduction
The demand for revision and salvage procedures after knee arthroplasty is increasing as the number of primary procedures increases. Surgical salvage techniques when revision arthroplasty is contra-indicated include above knee amputation and arthrodesis. The results of arthrodesis are functionally superior to those of amputation but not all techniques of arthrodesis are associated with good results.
Materials and methods
We present a single surgeon series of 14 consecutive patients who underwent arthrodesis of the knee with a customised intramedullary coupled nail (Mayday arthrodesis nail, Orthodesign Ltd, UK). All patients had a failed knee arthroplasty due to persistent sepsis. Pre-operative scaled radiographs were used to design and manufacture a custom-made implant for each patient. An identical surgical technique and post-operative rehabilitation regime were used in each case.
Results
The mean hospital stay was 12 days (range 6–24). Union was achieved in all but one patient at a mean of 4 months (range 3–10). One diabetic patient required subsequent above knee amputation for infected non-union. Two other patients had significant transient complications.
Conclusion
We have found that the Mayday nail offers a straightforward, reproducible surgical option for difficult salvage surgery. Good results have been obtained in the majority of cases, avoiding the devastating consequences of above knee amputation.
Similar content being viewed by others
References
Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC (2004) Infection after total knee arthroplasty. J Bone Joint Surg 86-B:688–691
Buechel FF, Femino FP, D-Alessio J (2004) Primary exchange revision arthroplasty for infected total knee replacement: a long-term study. Am J Orthop 33(4):190–198
Callaghan JJ, Katz RP, Johnston RC (1999) One-stage revision surgery of the infected hip. A minimum 10 year follow up study. Clin Orthop 369:139–143
Conway JD, Mont MA, Bezwada HP (2004) Arthrodesis of the knee. J Bone Joint Surg 86-A:835–848
Gille J, Ince A, González O, Katzer A, Loehr JF (2006) Single stage revision of peri-prosthetic infection following total elbow replacement. J Bone Joint Surg 88-B (10):1341–1346
Gore DR, Gassner K (2003) Use of an intramedullary rod in knee arthrodesis following failed total knee arthrolasty. J Knee Surgery 16(3):165–167
Klinger HM, Spahn G, Schultz W, Baums MH (2006) Arthrodesis of the knee after failed infected total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 14(5):447–453
Knutson K, Hovelius L, Lindstrand A, Lidgren L (1984) Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases. Clin Orthop 191:202–211
Luria S, Kandel L, Segal D, Leibergall M, Mattan Y (2003) Revision total knee arthroplasty. J Isr Med Assoc 5(8):552–555
Mabry TM, Jacofsky DJ, Haidukewych GJ, Hanssen AD (2007) Comparison of intramedullary nailing and external fixation knee arthrodesis for the infected knee replacement. Clin Orthop. E-published 26-04-2007
McQueen DA, Cooke FW, Hahn DL (2006) Knee arthrodesis with the Wichita fusion nail: an outcome comparison. Clin Orthop 446:132–139
Monzotti A, Pullen C, Guerrescli F (2001) The Ilizarov method for failed knee arthrodesis following septic total knee arthroplasty. Knee 8(2):135–138
Nichols SJ, Landon GC, Tullos HS (1991) Arthrodesis with dual plates after failed total knee arthroplasty. J Bone Joint Surg 73-A:1020–1024
Pritchett JW, Mallin BA, Matthews AC (1988) Knee arthrodesis with tension-band plate. J Bone Joint Surg 70-A:285–288
Rorabeck CH (2002) Salvage of infected total knee fusion––the last option. Clin Orthop 404:139–142
Sierra RJ, Transdale RT, Pagnano MW (2003) Above knee amputation after total knee replacement. J bone Joint Surg 85-A:1000–1004
Stiehl JB, Hanel DP (1993) Knee arthrodesis using combined intramedullary and plate fixation. Clin Orthop 294:238–241
Thornhill T, Dalziel R, Sledge C (1982) Alternatives to arthrodesis for the failed total knee arthroplasty. Clin Orthop 170:131–140
Wang CJ, Hsieh MC, Huang TW, Wang JW, Chen HS, Lin CY (2004) Clinical outcome and patient satisfaction in aseptic and septic revision total knee arthroplasty. Knee 11(1):45–49
White S.P, Porteous AJ, Newman H, Mintowt-Czyz W, Barr V (2003) Arthrodesis of the knee using a custom-made intramedullary coupled device. J Bone Joint Surg 85-B:57–61
Wiedel JD (2002) Salvage of infected total knee replacement. Clin Orthop 404:113–115
Wilde AH, Stearns KL (1989) Intramedullary fixation of arthrodesis of the knee after infected total knee arthroplasty. Clin Orthop 248:87–92
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors did not receive any outside funding, payments, grants or benefits from a foundation, fund or commercial entity in support of this research.
Rights and permissions
About this article
Cite this article
Senior, C.J., da Assunção, R.E. & Barlow, I.W. Knee arthrodesis for limb salvage with an intramedullary coupled nail. Arch Orthop Trauma Surg 128, 683–687 (2008). https://doi.org/10.1007/s00402-007-0386-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-007-0386-8