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The Journal of Bone and Joint Surgery, Vol 76, Issue 6 870-877, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Intramedullary arthrodesis of the knee after failed total knee arthroplasty
DE Ellingsen and JA Rand
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905.
Eighteen patients (eighteen knees) were managed with an intramedullary
arthrodesis after a failed total knee arthroplasty. Twelve knees had had a
revision total knee arthroplasty and six, a primary total knee
arthroplasty. Three knees had had failure of a hinged prosthesis. In eleven
knees, the arthroplasty had failed because of infection. Nine patients had
had previous attempts at arthrodesis with external fixation. The average
duration of the operation was six hours, and the average blood replacement
was 2975 milliliters. A vascularized fibular pedicle graft was used in four
patients. At a mean of thirty-seven months after the arthrodesis, sixteen
of the eighteen patients had a complete radiographic union. The mean time
to union was 5.5 months. Although a high rate of union was achieved in
these patients, complications occurred in ten of the eighteen knees and
this must be considered. Intramedullary arthrodesis is a successful method
of salvage for a failed total knee arthroplasty or one complicated by
infection that is not amenable to revision, but it is technically demanding
and has frequent complications.
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