The Journal of Bone and Joint Surgery, Vol 73, Issue 6 907-913, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Arthrodesis of the knee with an intramedullary nail
BG Donley, LS Matthews and H Kaufer
University of Michigan Medical Center, Ann Arbor.
The cases of twenty patients who had an arthrodesis in which an
intramedullary nail was used for stabilization were reviewed at an average
follow-up of six years. The predominant indications were infection after
total knee arthroplasty and post-traumatic pain and instability. Other
indications included aseptic loosening of the components of a total knee
arthroplasty, reconstruction after resection of a giant-cell tumor,
non-union of a fracture of the distal part of the femur or the proximal
part of the tibia, and failed external-compression arthrodesis. Success was
achieved in seventeen patients (85 per cent), and functional stability
immediately postoperatively was gained in all twenty. Of the three patients
in whom the arthrodesis failed, all had sustained an intraoperative
fracture, and infection eventually developed. Of the twelve nails that were
secured to the greater trochanter with a loop of stainless-steel wire, none
showed evidence of proximal migration. Of the eight nails that were not
thus secured, two migrated proximally, necessitating removal of the nail.
Two drawbacks to this operation are the long duration and the large amount
of blood that is lost. The major advantage is that a high percentage of
patients have progression to a stable fusion despite serious problems.
Furthermore, all but seven patients (including the six who had a tumor or
who had sustained an intraoperative fracture) were able to bear full weight
by the second postoperative week. Only a few patients needed an external
support for walking.
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