The Journal of Bone and Joint Surgery (American). 2006;88:553-558.
doi:10.2106/JBJS.E.00575
© 2006 The Journal of Bone and Joint Surgery, Inc.
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 Adult Knee Reconstruction Test 11: Spring 2006 (publication date May 15, 20...
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Arthrodesis of the Knee with a Long Intramedullary Nail Following the Failure of a Total Knee Arthroplasty as the Result of Infection

Konstantinos Bargiotas, MD1, David Wohlrab, MD1, Jeffrey J. Sewecke, DO1, Gregory Lavinge, MD1, Patrick J. DeMeo, MD1 and Nicholas G. Sotereanos, MD1

1 Federal North, 1307 Federal North Street, Pittsburgh, PA 15212. E-mail address for K. Bargiotas: kbargio{at}yahoo.gr. E-mail address for N.G. Sotereanos: nsotereanos{at}usa.net

Investigation performed at the Department of Orthopaedics, Allegheny General Hospital, Pittsburgh, Pennsylvania

A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Knee arthrodesis can be an effective treatment option for relieving pain and restoring some function after the failure of a total knee arthroplasty as the result of infection. The purpose of the present study was to review the outcome of a staged approach for arthrodesis of the knee with a long intramedullary nail after the failure of a total knee arthroplasty as the result of infection.

Methods: We reviewed the results for twelve patients who underwent knee arthrodesis after the removal of a prosthesis because of infection. The study group included seven women and five men who had an average age of sixty-eight years at the time of the arthrodesis. All patients were managed with a staged protocol. Implant removal, débridement, and insertion of antibiotic cement spacers was followed by the administration of systemic antibiotics. Provided that clinical and laboratory data suggested eradication of the infection, arthrodesis of the affected knee with use of a long intramedullary nail was carried out. Clinical and laboratory evaluation and radiographic analysis were performed after an average duration of follow-up of 4.1 years.

Results: Solid union was achieved in ten of the twelve knees. The average time to union was 5.5 months. One patient had an above-the-knee amputation because of recurrence of infection. In another patient, nail breakage occurred three years following implantation. The average limb-length discrepancy was 5.5 cm. The mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 41 to 64 points. None of the seven patients who underwent arthrodesis with a technique involving convex-to-concave reamers had a complication, and the average time to union for these seven patients was shorter than that for the remaining five patients (4.3 compared with 7.4 months).

Conclusions: We believe that obtaining large surfaces of bleeding contact bone during arthrodesis following staged treatment of an infection at the site of a failed total knee arthroplasty contributes to stability and enhances bone-healing. Staged arthrodesis with use of a long intramedullary nail and convex-to-concave preparation of bone ends provided a painless functional gait with low complication and reoperation rates in this challenging group of patients.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Related articles in JBJS:

Arthrodesis of the Knee with a Long Intramedullary Nail Following the Failure of a Total Knee Arthroplasty as the Result of Infection. Surgical Technique
Konstantinos Bargiotas, David Wohlrab, Jeffrey J. Sewecke, Gregory Lavinge, Patrick J. DeMeo, and Nicholas G. Sotereanos
JBJS 2007 89: 103-110. [Abstract] [Full Text]  



Letters to the Editor:

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Arthrodesis of the Knee Without Limb Shortening
Levent Altinel, M.D., et al.
JBJS Online, 23 May 2006 [Full text]