Knee arthrodesis for limb salvage with an intramedullary coupled nail.
BACKGROUND
The demand for revision and salvage procedures after knee arthroplasty is increasing as the number of primary procedures increases. Surgical salvage techniques when revision arthroplasty is contra-indicated include above knee amputation and arthrodesis. The results of arthrodesis are functionally superior to those of amputation but not all techniques of arthrodesis are associated with good results.


METHODS
We present a single surgeon series of 14 consecutive patients who underwent arthrodesis of the knee with a customised intramedullary coupled nail (Mayday arthrodesis nail, Orthodesign Ltd, UK). All patients had a failed knee arthroplasty due to persistent sepsis. Pre-operative scaled radiographs were used to design and manufacture a custom-made implant for each patient. An identical surgical technique and post-operative rehabilitation regime were used in each case.


RESULTS
The mean hospital stay was 12 days (range 6-24). Union was achieved in all but one patient at a mean of 4 months (range 3-10). One diabetic patient required subsequent above knee amputation for infected non-union. Two other patients had significant transient complications.


CONCLUSIONS
We have found that the Mayday nail offers a straightforward, reproducible surgical option for difficult salvage surgery. Good results have been obtained in the majority of cases, avoiding the devastating consequences of above knee amputation.
Senior
Colin J
CJ
colsenior@hotmail.com
da Assunção
Ruy E
RE
Barlow
Ian W
IW
D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage / Q000295:instrumentation* / Q000379:methods; D008297:Male; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D010149:Postoperative Pain / Q000503:physiopathology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000628:therapy; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome