Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results

Abstract

Purpose Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA). Methods Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes. Results Spacer exchange was necessary for infection persistence in one case. At a minimum two year follow-up, 34 patients (89.5 %) showed no infection recurrence; among these 34 patients, 29 (85.3 %) reported no or moderate pain [visual analogue scale (VAS) ≤3]; mild to moderate handicap (Lequesne Algofunctional Index<7.5) was observed in 18 patients (52.9 %). No patient underwent revision for aseptic loosening, and no nail breakage was observed. Conclusions Two-stage cementless intramedullary nailing without achieving bone-to-bone fusion is a viable option for treating chronically infected TKA in selected, complex cases.

Novel, static, permanent spacers to treat chronic knee periprosthetic joint infections

“…The present study revealed no signs of residual instability in any patient and a low recurrent infection rate of 6.6% (1/15) at the final follow-up. The recurrent infection rate in our study was lower than the reported results in other studies using cement with intramedullary nailing [ 16 , 18 , 19 ], in which recurrent infection rate ranged from 10.5 to 23%. Potential reasons could be as follows: first, antibiotic-impregnated bone cement filled serious bone defect and release more antibiotic to eradicate infections.…”

“…However, it was demonstrated more stable spacer could be obtained if it could be strengthened. Sara Scarponi et al [ 18 ] reported no incidence of mechanical complication at minimum follow-up of two years in their study of PJI patients treated with static spacer which was strengthened by cementless modular intramedullary nail to achieve knee arthrodesis. Kotwal et al [ 16 ] reported in a cohort of 58 medically compromised patients who were treated by similar approach, followed up for an average time of 29.4 months, no patient underwent revision for mechanical complications.…”

Re-infection rates and clinical outcomes following arthrodesis with intramedullary nail and external fixator for infected knee prosthesis: a systematic review and meta-analysis.

“…Differently from the meta-analysis of White et al [ 11 ], we assessed bone fusion as a secondary outcome. Indeed, achieving bone fusion may not be necessary in knee arthrodesis with the use of modular locking IM nails [ 33 ]. The eligibility criteria and selection of outcomes in the current analysis also enabled us to include studies on knee arthrodesis performed with the most recent modular IM nails that were completely excluded from the study of White et al [ 11 ].…”

“…With the numbers available, no differences in fusion rate emerged between long and short periarticular nails. Several recent studies reporting results of modular IM implants disregarded bony union as an endpoint since it was not considered essential to obtain successful outcome [ 5 , 10 , 12 , 23 , 26 , 29 , 33 ]. Conversely, bony union is of outmost importance for EF arthrodesis.…”

Knee arthroplasty today

“…In order to avoid such consequences an interesting and viable option is the suggested use of an intramedullary cementless nail [25] that does not require bone contact with the residual gap filled with antibiotic loaded cement providing a 89.5 % complete infection regression in a two year follow up.…”