Knee arthodesis using a modular customized intramedullary nail.
BACKGROUND
Arthrodesis of the knee, particularly in infectious situations, can be achieved using either an external fixator or an intramedullary device. The objective of this study is to report the clinical, functional, and radiographic outcomes of a continuous series of 19 cases of knee arthrodesis using a customized modular intramedullary nailing system.


OBJECTIVE
The modular intramedullary nail offers a satisfactory functional result while maintaining limb length, in spite of a nonunion risk, since acting like a true endoprosthesis.


METHODS
In our retrospective series of 19 patients, the main source of patients were infected total knee replacements. The nail was customized from assembling a dual surface-sanded titanium component (femoral and tibial). The Lequesne Algofunctional score and the WOMAC score were recorded, as well as the length discrepancy between the lower extremities. Arthrodesis consolidation and the nail's fit in the shaft were verified on anterior-posterior (AP) and lateral radiographs.


RESULTS
Five complications were observed: one anterior cortical break, one excessive tibial rotation, two cases of delayed union, and one nail revision due to residual nail instability. The postoperative Lequesne Algofunctional score was 13/24 and the WOMAC score 57/100. The nonunion rate was 32%. From a functional point of view, the patients who did not achieve complete union and those who did had similar scores. The subjective results were not as good in patients who did not achieve final consolidation.


CONCLUSIONS
Modular intramedullary nailing simplifies the technique, shortens the procedure, and reduces the amount of blood loss at surgery. Our nonunion rate was high, although the functional result did not seem compromised by such nonunion. The risk of long-term implant failure was not studied and requires longer follow-up studies.


METHODS
Level IV therapeutic study.
Letartre
R
R
Department of Orthopaedic Surgery D, Roger Salengro Hospital, Lille Teaching Medical Center, Lille, France. romainletartre@nordgenou.fr
Combes
A
A
Autissier
G
G
Bonnevialle
N
N
Gougeon
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001174:Arthrodesis / Q000295:instrumentation*; D001424:Bacterial Infections / Q000601:surgery; D004343:Drug Implants; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D007870:Leg Length Inequality / Q000517:prevention & control; D008297:Male; D008768:Methylmethacrylates / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage; D014945:Wound Healing / Q000502:physiology
D000900:Anti-Bacterial Agents; D004343:Drug Implants; D005839:Gentamicins; D008768:Methylmethacrylates; C030159:gentamicin-polymethylmethacrylate bead; D014640:Vancomycin