title: Arthrodesis of the knee following failed arthroplasty.
abstract: OBJECTIVE
  Primary stability in arthrodesis of the knee can be achieved by external fixation, intramedullary nailing or plate fixation. Each method has different features and results. We present a practical algorithm for arthrodesis of the knee following a failed (infected) arthroplasty, based on our own results and a literature review.
  
  
  METHODS
  Between 2004 and 2010, patients were included with an indication for arthrodesis after failed (revision) arthroplasty of the knee. Patients were analyzed with respect to indication, fusion method and bone contact. End-point was solid fusion.
  
  
  RESULTS
  Twenty-six arthrodeses were performed. Eighteen patients were treated because of an infected arthroplasty. In total, ten external fixators, ten intramedullary nails and six plate fixations were applied; solid fusion was achieved in 3/10, 8/10 and 3/6, respectively.
  
  
  CONCLUSIONS
  There is no definite answer as to which method is superior in performing an arthrodesis of the knee. Intramedullary nailing achieved the best fusion rates, but was used most in cases without--or cured--infection. Our data and the contemporary literature suggest that external fixation can be abandoned as standard fusion method, but can be of use following persisting infection. The Ilizarov circular external fixator, however, seems to render high fusion rates. Good patient selection and appropriate individual treatment are the key to a successful arthrodesis. Based upon these findings, a practical algorithm was developed.
authors.affiliation: Department of Orthopedics, Postoperative Joint Infection Unit, St Maartenskliniek, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands, paulvanrensch@gmail.com.
authors.forename: P J H
authors.initials: PJ
authors.lastname: Van Rensch
authors.forename: G J
authors.initials: GJ
authors.lastname: Van de Pol
authors.forename: J H M
authors.initials: JH
authors.lastname: Goosen
authors.forename: A B
authors.initials: AB
authors.lastname: Wymenga
authors.forename: F H R
authors.initials: FH
authors.lastname: De Man
mesh_terms: D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure