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Scientific Articles:
Konstantinos Bargiotas, David Wohlrab, Jeffrey J. Sewecke, Gregory Lavinge, Patrick J. DeMeo, and Nicholas G. Sotereanos
Arthrodesis of the Knee with a Long Intramedullary Nail Following the Failure of a Total Knee Arthroplasty as the Result of Infection
J Bone Joint Surg Am 2006; 88: 553-558 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Arthrodesis of the Knee Without Limb Shortening
Levent Altinel, M.D., Kamil Cagri Kose, M.D., and Oguz Cebesoy, M.D.   (23 May 2006)

Arthrodesis of the Knee Without Limb Shortening 23 May 2006
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Levent Altinel, M.D.,
Assistant Professor
Afyon Kocatepe University, Faculty of Medicine, Afyon, TURKEY,
Kamil Cagri Kose, M.D., and Oguz Cebesoy, M.D.

Send letter to journal:
Re: Arthrodesis of the Knee Without Limb Shortening

levent_altinel{at}hotmail.com Levent Altinel, M.D., et al.

To the Editor:

I would like to comment on the article by Bargiotas, et al(1). Failure of TKA because of infection is a devastating complication and treatment may require removal of components, thorough debridement, and arthrodesis. In the author’s study, the mean leg length discrepancy following arthrodesis using an intramedullary nail was 5.5 cm.

In our experience, the resulting intraoperative defect can be even larger than anticipated because of the extensive debridement and shaping of the bone ends so that they are suitable for arthrodesis. In addition, intramedullary nails are not free of complications. Nail breakage, migration, and instability secondary to differences in the intramedullary diameters of the femur and tibia can occur.

To avoid such shortening, we prefer to perform leg lengthening as part of the arthrodesis for failed infected knee replacements using the Ilizarov fixator. The Ilizarov fixator can be used when other athrodesis techniques fail(2) and even in the presence of active infection, substantial shortening, and bone loss(3). The Ilizarov fixator offers the advantages of early weightbearing, a high union rate, and simultaneous lengthening of the extremity.

In summary, arthrodesis and restoration of leg length with the Ilizarov fixator is a superior alternative to intramedullary nails when performing arthrodesis in a patient with an infected total knee arthroplasty.

References:

1. Bargiotas K, Wohlrab D, Sewecke JJ, Lavinge G, Demeo PJ, Sotereanos NG. Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. J Bone Joint Surg Am. 2006 Mar;88(3):553-8.

2. Oostenbroek HJ, van Roermund PM. Arthrodesis of the knee after an infected arthroplasty using the Ilizarov method. J Bone Joint Surg Br. 2001 Jan;83(1):50-4.

3.Manzotti A, Pullen C, Deromedis B, Catagni MA. Knee arthrodesis after infected total knee arthroplasty using the Ilizarov method. Clin Orthop Relat Res. 2001 Aug;(389):143-9.