Knee arthrodesis using a customised modular intramedullary nail in failed infected total knee arthroplasty

Abstract

Level IV, retrospective cohort study.

Modern Techniques in Knee Arthrodesis

“…Additionally for long IMNs, when compared to modular shorter nails, extraction, when needed, was proven to be easier, faster, and cause less bone damage, and did not require taking down the fusion site like in modular nails [22,23] . However, higher rates of persistent infection have been identified in this technique and other intramedullary procedures [4,18,20] . Recently, Schwarzkopf et al, demonstrated an 81.…”

“…The IM nail is inserted in an anterograde fashion through the piriformis fossa, similar to a femoral nail, while the distal aspect of the nail should sit close to the tibial plafond, similar to a tibial intramedullary nail [1,18,19] . When bony defects are severe, allograft and autograft bone grafts or a metal or polyethylene spacer are different options available to help minimize leg length discrepancy (LLD) with both short and long IM nails [1,4,14,20] . The disadvantage of this option is a decrease in rate and strength of the bony fusion site.…”

“…Following insertion, the two nails are then joined using one of a number of interlocking mechanisms, depending on the specific manufacturer and type of nail used [25] . The advantages of this procedure include minimization of leg length discrepancy, the ability to immediately bear weight on the leg despite severe bone loss, avoidance of pin-track infections, and the use of multiple interlocking screws, which may enhance the vertical and rotational stability of the knee and ultimately improve fusion rate [13,14,20,22,[26][27][28] . Carrying out a knee arthrodesis, using a modular nail, is not a demanding procedure and in one study, which analyzed the effects of a Wichita Fusion Nail (Stryker Orthopedics, Mahwah, New Jersey, USA) there were no differences in fusion rates between surgeons who were performing the surgery for the first time and those who were more experienced [29] .…”

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

“…Whereas the proposed techniques do achieve bone fusion and infection control in the majority of cases, residual limb-length discrepancy and possible nonunion are the primary limits of knee arthrodesis following septic TKA. To overcome these problems, intramedullary nailing without bone fusion has been recently proposed in limited series of patients [17,22]. Advantages of this option include no need for bone fusion and hence no risk of nonunion, early recovery and reduced limb-length inequality.…”

Knee Arthrodesis in Severe Injured Knee Joints

“…very rare and unique patients require other treatment strategies than in cases of failed knee replacement. Alternative methods to the knee arthrodesis nail are modular nails [11], plating after lengthening [6], external frame fixation or even amputation [6].…”