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The Journal of Bone and Joint Surgery, Vol 72, Issue 3 433-442, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Arthrodesis of the knee with intramedullary nail fixation
J Puranen, P Kortelainen and P Jalovaara
Department of Surgery, University of Oulu, Finland.
Thirty-three patients had an arthrodesis of the knee by means of an
intramedullary nail introduced through the greater trochanter. Fifteen of
the procedures were done for a failed knee arthroplasty; eight had failed
because of infection and seven, because of aseptic loosening. Twenty-nine
of the thirty-three knees united three to four months after the first
attempt at arthrodesis and three united after technical errors were
corrected. One knee had a broken nail and a non-union; this was still
untreated at the time of writing. Four nails broke: three in the line of
fusion and one in the line of an infected supracondylar pseudarthrosis of
the femur. No new infections developed after the arthrodesis. Three
patients had had an infection and a chronic fistula before the arthrodesis,
and the fistulae healed six, fourteen, and eighteen months postoperatively.
In another patient, who had had infection and necrosis of the skin
preoperatively, the wound healed in six months. All of these knees healed
without an additional major operation. The functional result was
satisfactory in all patients. After the arthrodesis, seventeen of the
thirty-three patients needed less aid when walking, and no patient needed
more aid. Fusion of the knee with a long intramedullary nail can be safe
and effective, even in the presence of infection, if the revision is
performed properly and certain technical principles are followed. It is
especially important to establish good contact between the resected bones.
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