Intramedullary Arthrodesis of the Knee in the Treatment of Sepsis after TKR

Abstract

Infection is a devastating complication following total knee replacement (TKR). In the majority of cases, single-or two-stage revision has excellent results in eradicating infection and restoring function. Rarely, recurrent infection requires alternative treatments such as resection, amputation, or arthrodesis.

Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series

“…This is consistent with other reports, showing that intramedullary arthrodesis is a valuable treatment for refractory infection after TKR [27]. A total of 22 patients treated with the KAI had been investigated of which 8 patients had already deceased at the time of follow-up.…”

“…Compromised bone stock and soft-tissue following removal of a total knee replacement (TKR) can impair the premise for and longevity of revision total knee replacement [27]. Especially after removal of an infected TKR, conditions such as recurring infections, ligamentous instability, extensor mechanism deficiency, extensive bone defects, or osteonecrosis may necessitate arthrodesis of the knee joint as a salvage procedure for limb preservation.…”

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

“…In 53 knees, a solid fusion was demonstrated clinically and radiographically [31]. For these reasons this has been proposed as the procedure of choice by different authors to achieve bone fusion after failed infected TKA [8,10,13,16,28,32,33]. even if the procedure is technically demanding, especially when a long, curved Küntscher nail is used, requiring long operative time and being associated with large blood loss; moreover, risk of nail breakage or migration has been reported, and limb-length discrepancy remains a frequent occurrence [10,34].…”

“…Nelson and Evarts were probably the first to report knee arthrodesis as a treatment for failed TKA [9]. Knee arthrodesis has thereafter been proposed for septic knee prosthesis in the presence of one or more of the following conditions: highly virulent or multi-drug-resistant microorganisms, extensor apparatus deficit, severe bone loss or soft-tissue defect, multiple previous revision surgeries and patient's refusal to further prosthesis reimplantation or amputation [10][11][12][13][14][15][16][17][18].…”

Tecnica delle artrodesi di ginocchio

“…La scelta del trattamento, basata sull'analisi accurata e multidisciplinare del caso, deve essere per quanto possibile individualizzata in funzione delle condizioni e delle esigenze funzionali di ogni singolo paziente. L'analisi della letteratura mostra che in casi selezionati questa metodica trova ancora oggi, nelle complicanze settiche di protesi di ginocchio, una valida applicazione [21,28,30,[32][33][34][35][36][37]. Le tecniche più frequentemente impiegate per eseguire un'artrodesi di ginocchio sono l'inchiodamento endomidollare e la fissazione esterna ed entrambe le metodiche mostrano, nella maggioranza dei pazienti, risultati clinici favorevoli sulla risoluzione dell'infezione e la riduzione del dolore [28,30,32,33,35,37].…”