title: Distraction arthrodesis with intramedullary nail and mixed bone grafting after failed infected total knee arthroplasty.
abstract: OBJECTIVE
  The purpose of this study was to determine the success rate of the distraction arthrodesis, which was attempted to maintain the limb length during arthrodesis using an intramedullary nail and mixed bone grafting, in terms of the eradication of infection, solid union, and functional outcome. The hypothesis was that distraction arthrodesis would be successful in union and elimination of infection with minimal limb shortening and a satisfactory functional outcome despite large bone defects.
  
  
  METHODS
  Eight patients were managed by arthrodesis using a Huckstep intramedullary nail and massive corticocancellous bone chip grafts from autologous iliac bone and deep-frozen femoral head allografts were included in the study. The mean age of the patients was 65.5 ± 7.1 years, and the follow-up duration was 52.1 ± 21.3 months. A mean of 5.3 ± 1.3 surgical procedures had been performed before arthrodesis. The mean longest and shortest distances of the bone defect were 58.6 ± 10.3 and 34.6 ± 7.0 mm, respectively.
  
  
  RESULTS
  Radiological union was obtained in all cases at a mean of 9.9 ± 1.9 months. The mean postoperative limb shortening was 11.0 ± 7.3 mm when compared to the contralateral knee. The mean Knee Society score was 59.9 ± 9.2, and the function score was 38.8 ± 13.3. No additional procedures were required for any of the patients.
  
  
  CONCLUSIONS
  Distraction arthrodesis of infected knees following total knee arthroplasty demonstrated union and eradication of infection in all patients and a large tibiofemoral gap due to the severe bone defect could be managed with massive bone chip grafts. This method of arthrodesis would be a reliable and an effective method for failed total knee arthroplasty when two-staged reimplantation fails or is not attainable.
authors: Department of Orthopaedic Surgery, Seoul Nation University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. shknee@snu.ac.kr
authors: Sahnghoon
authors: S
authors: Lee
authors: Jak
authors: J
authors: Jang
authors: Sang Cheol
authors: SC
authors: Seong
authors: Myung Chul
authors: MC
authors: Lee
mesh_terms: D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee; D001858:Bone Nails; D016025:Bone Transplantation; D005260:Female; D005270:Femur Head / Q000637:transplantation; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000601:surgery; D006801:Humans; D007085:Ilium / Q000637:transplantation; D007720:Knee Prosthesis / Q000009:adverse effects*; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome