title: Infected total knee arthroplasty treated with arthrodesis using a modular nail.
abstract: Failed treatment of infected total knee replacement presents few attractive surgical options. Knee arthrodesis is challenging surgically and can be complicated by nonunion, malunion, or recurrent infection. Recently, a modular titanium intramedullary nail has been used in an attempt to reduce the incidence of nonunion and the rate of complications. In the present study, a review of the results of knee arthrodesis after infected total knee arthroplasty in 21 patients at three large academic institutions was performed. All patients were followed up for a mean of 2.4 years (range, 2-7.5 years). The mean age of the patients was 64 years. The mean number of previous operations was four (range, 2-9 operations). A solid arthrodesis was achieved without additional surgical treatment in 20 of 21 patients (95%). The mean time to fusion was 6.3 months. The one patient who suffered a nonunion achieved fusion after a subsequent bone grafting procedure. Based on the present study, intramedullary arthrodesis with a coupled titanium nail, is a reliable, effective method of achieving fusion after infection of a total knee arthroplasty. This procedure resulted in a high rate of fusion and a lower rate of complications when compared with traditional methods of arthrodesis.
authors.affiliation: Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Baltimore, Maryland, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Waldman
authors.forename: M A
authors.initials: MA
authors.lastname: Mont
authors.forename: K R
authors.initials: KR
authors.lastname: Payman
authors.forename: A A
authors.initials: AA
authors.lastname: Freiberg
authors.forename: R E
authors.initials: RE
authors.lastname: Windsor
authors.forename: T P
authors.initials: TP
authors.lastname: Sculco
authors.forename: D S
authors.initials: DS
authors.lastname: Hungerford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography