title: Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA.
abstract: BACKGROUND
  Knee arthrodesis can be an effective treatment after an infected revision Total Knee Arthroplasty (TKA). The main hypothesis of this study is that a two-stage arthrodesis of the knee using a press-fit, modular intramedullary nail and antibiotic loaded cement, to fill the residual gap between the bone surfaces, prevents an excessive limb shortening, providing satisfactory clinical and functional results even without direct bone-on-bone fusion.
  
  
  METHODS
  The study included 22 patients who underwent knee arthrodesis between 2004 and 2009 because of recurrent infection following revision-TKA (R-TKA). Clinical and functional evaluations were performed using the Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score. A postoperative clinical and radiographical evaluation of the residual limb-length discrepancy was conducted by three independent observers.
  
  
  RESULTS
  VAS and LAS results showed a significant improvement with respect to the preoperative condition. The mean leg length discrepancy was less than 1cm. There were three recurrent infections that needed further surgical treatment.
  
  
  CONCLUSIONS
  This study demonstrated that reinfection after Revision of total knee Arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail, along with an antibiotic loaded cement spacer and that satisfactory results can be obtained without direct bone-on-bone fusion.
authors.affiliation: Rizzoli Orthopaedic Institute, Biomechanics Laboratory, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Iacono
authors.forename: Danilo
authors.initials: D
authors.lastname: Bruni
authors.forename: Mirco
authors.initials: M
authors.lastname: Lo Presti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raspugli
authors.forename: Alice
authors.initials: A
authors.lastname: Bondi
authors.forename: Bharat
authors.initials: B
authors.lastname: Sharma
authors.forename: Maurilio
authors.initials: M
authors.lastname: Marcacci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001174:Arthrodesis / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements / Q000494:pharmacology; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements