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Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series

  • Knee Revision Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Failed total knee replacement with compromised bone and soft-tissues can be challenging. In these situations, arthrodesis remains a treatment option of a limb-saving procedure.

Methods

We investigated the outcome of treatment with an intramedullary cemented knee arthrodesis nail implanted in 22 consecutive patients with forlorn situations after failed total knee replacement.

Results

There were three major complications due to re-infection and two minor complications due to wound-healing disturbances that healed with the implant retained after an average follow-up of 3.4 years. Clinical examination, Short Form-36 and Oxford knee scores revealed low pain levels, safe implant anchorage, and improved stability of the knee, whilst autonomous mobility utilizing walking aids was still possible.

Conclusion

Bridging knee arthrodesis with an intramedullary nail is a valuable salvage procedure with acceptable clinical results. As recurring infection remains the most challenging complication, regular clinical and radiological follow-up examinations are necessary following implant-related knee arthrodesis to allow timely intervention in case of loosening.

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References

  1. Anract P, Missenard G, Jeanrot C, Dubois V, Tomeno B (2001) Knee reconstruction with prosthesis and muscle flap after total arthrectomy. Clin Orthop Relat Res(384):208–216

  2. Archibeck MJ, White RE Jr (2006) What’s new in adult reconstructive knee surgery. J Bone Joint Surg Am 88(7):1677–1686

    Article  PubMed  Google Scholar 

  3. Ashby E, Grocott MP, Haddad FS (2008) Outcome measures for orthopaedic interventions on the hip. J Bone Joint Surg Br 90(5):545–549

    Article  PubMed  CAS  Google Scholar 

  4. Bargiotas K, Wohlrab D, Sewecke JJ, Lavinge G, DeMeo PJ, Sotereanos NG (2007) Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. Surgical technique. J Bone Joint Surg Am 89(Suppl 2 Pt.1):103–110

    Article  PubMed  Google Scholar 

  5. Benson ER, Resine ST, Lewis CG (1998) Functional outcome of arthrodesis for failed total knee arthroplasty. Orthopedics 21(8):875–879

    PubMed  CAS  Google Scholar 

  6. Conway JD, Mont MA, Bezwada HP (2004) Arthrodesis of the knee. J Bone Joint Surg Am 86-A((4)):835–848

    PubMed  Google Scholar 

  7. Crockarell JR Jr, Mihalko MJ (2005) Knee arthrodesis using an intramedullary nail. J Arthroplasty 20(6):703–708

    Article  PubMed  Google Scholar 

  8. Davies B, Datta D (2003) Mobility outcome following unilateral lower limb amputation. Prosthet Orthot Int 27(3):186–190

    Article  PubMed  CAS  Google Scholar 

  9. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80(1):63–69

    Article  PubMed  CAS  Google Scholar 

  10. De Vil J, Almqvist KF, Vanheeren P, Boone B, Verdonk R (2008) Knee arthrodesis with an intramedullary nail: a retrospective study. Knee Surg Sports Traumatol Arthrosc 16(7):645–650

    Article  PubMed  Google Scholar 

  11. Glazebrook M, Daniels T, Younger A et al (2008) Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg Am 90(3):499–505

    Article  PubMed  Google Scholar 

  12. Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171

    Article  PubMed  Google Scholar 

  13. Hagberg K, Branemark R (2001) Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems. Prosthet Orthot Int 25(3):186–194

    Article  PubMed  CAS  Google Scholar 

  14. Hanusch B, Lou TN, Warriner G, Hui A, Gregg P (2010) Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomised controlled trial. Int Orthop 34(3):349–354

    Article  PubMed  Google Scholar 

  15. Jamsen E, Varonen M, Huhtala H et al (2010) Incidence of prosthetic joint infections after primary knee arthroplasty. J Arthroplasty 25(1):87–92

    Article  PubMed  Google Scholar 

  16. Jung KA, Lee SC, Song MB (2009) Arthrodesis of the knee using computer navigation in failed total knee arthroplasty. Orthopedics 32(3):209

    Article  PubMed  Google Scholar 

  17. Kinkel S, Lehner B, Kleinhans JA, Jakubowitz E, Ewerbeck V, Heisel C (2010) Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses. J Surg Oncol 101(2):166–169

    PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB (2001) Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am 83-A(12):1856–1864

    PubMed  CAS  Google Scholar 

  20. 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 Relat Res 464:11–15

    PubMed  Google Scholar 

  21. McQueen DA, Cooke FW, Hahn DL (2006) Knee arthrodesis with the Wichita Fusion Nail: an outcome comparison. Clin Orthop Relat Res 446:132–139

    Article  PubMed  CAS  Google Scholar 

  22. Puranen J, Kortelainen P, Jalovaara P (1990) Arthrodesis of the knee with intramedullary nail fixation. J Bone Joint Surg Am 72(3):433–442

    PubMed  CAS  Google Scholar 

  23. Rozbruch SR, Ilizarov S, Blyakher A (2005) Knee arthrodesis with simultaneous lengthening using the Ilizarov method. J Orthop Trauma 19(3):171–179

    Article  PubMed  Google Scholar 

  24. Senior CJ, da Assuncao RE, Barlow IW (2008) Knee arthrodesis for limb salvage with an intramedullary coupled nail. Arch Orthop Trauma Surg 128(7):683–687

    Article  PubMed  Google Scholar 

  25. Sierra RJ, Trousdale RT, Pagnano MW (2003) Above-the-knee amputation after a total knee replacement: prevalence, etiology, and functional outcome. J Bone Joint Surg Am 85-A(6):1000–1004

    PubMed  Google Scholar 

  26. Somayaji HS, Tsaggerides P, Ware HE, Dowd GS (2008) Knee arthrodesis—a review. Knee 15(4):247–254

    Article  PubMed  CAS  Google Scholar 

  27. Talmo CT, Bono JV, Figgie MP, Sculco TP, Laskin RS, Windsor RE (2007) Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR. HSS J 3(1):83–88

    Article  PubMed  Google Scholar 

  28. Utting MR, Newman JH (2004) Customised hinged knee replacements as a salvage procedure for failed total knee arthroplasty. Knee 11(6):475–479

    Article  PubMed  CAS  Google Scholar 

  29. Waldman BJ, Mont MA, Payman KR, et al. (1999) Infected total knee arthroplasty treated with arthrodesis using a modular nail. Clin Orthop Relat Res (367):230–237

  30. Yeoh D, Goddard R, Macnamara P et al (2008) A comparison of two techniques for knee arthrodesis: the custom made intramedullary Mayday nail versus a monoaxial external fixator. Knee 15(4):263–267

    Article  PubMed  Google Scholar 

  31. Yoo JH, Chang CB, Kang YG, Kim SJ, Seong SC, Kim TK (2011) Patient expectations of total knee replacement and their association with sociodemographic factors and functional status. J Bone Joint Surg Br 93(3):337–344

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Carl Neuerburg, Ralf Bieger, Sebastian Jung, Thomas Kappe, Heiko Reichel & Ralf Decking

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  1. Carl Neuerburg
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  2. Ralf Bieger
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  3. Sebastian Jung
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  4. Thomas Kappe
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  5. Heiko Reichel
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  6. Ralf Decking
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Correspondence to Thomas Kappe.

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Neuerburg, C., Bieger, R., Jung, S. et al. Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series. Arch Orthop Trauma Surg 132, 1183–1189 (2012). https://doi.org/10.1007/s00402-012-1534-3

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  • DOI: https://doi.org/10.1007/s00402-012-1534-3

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