title: Unsatisfactory outcome of arthrodesis performed after septic failure of revision total knee arthroplasty.
abstract: BACKGROUND
  Periprosthetic infection is one of the most dreaded orthopaedic complications. Current treatment procedures include one-stage or two-stage revision total knee arthroplasty. If the periprosthetic infection is no longer controllable after several revision total knee arthroplasties, many surgeons regard knee arthrodesis as a promising option. The aim of our study was to ascertain whether intramedullary nailing results in the suppression or eradication of an infection and to identify risk factors for persistent infection.
  
  
  METHODS
  All patients who had undergone intramedullary nailing following septic failure of revision total knee arthroplasty between 1997 and 2013 were included in the study. Pathogens, risk factors predisposing to persistent infection, and the rate of persistent infections were recorded. In addition, a visual analog scale (VAS) and Knee injury Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Lysholm, Short Form-36 (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires were completed to assess clinical outcomes and quality of life.
  
  
  RESULTS
  Twenty-six patients were included in the study. Thirteen (50%) had a persistent infection requiring additional revision surgery. Nineteen patients (73%) reported persistent pain (VAS score of >3). All scores showed marked impairment of quality of life.
  
  
  CONCLUSIONS
  Intramedullary nailing following septic failure of revision total knee arthroplasty must be regarded with skepticism, and we cannot recommend it. Repeat revision total knee arthroplasty or amputation should be considered as an alternative in such difficult cases.
authors.affiliation: Orthopaedic Department, Friedrich-Schiller-University, Campus Eisenberg, Klosterlausnitzer Strasse 81, Jena, 07607 Eisenberg, Germany. E-mail address for E. Röhner: e.roehner@krankenhaus-eisenberg.de.
authors.forename: Eric
authors.initials: E
authors.lastname: Röhner
authors.affiliation: Orthopaedic Department, Friedrich-Schiller-University, Campus Eisenberg, Klosterlausnitzer Strasse 81, Jena, 07607 Eisenberg, Germany. E-mail address for E. Röhner: e.roehner@krankenhaus-eisenberg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Windisch
authors.affiliation: Orthopaedic Department, Friedrich-Schiller-University, Campus Eisenberg, Klosterlausnitzer Strasse 81, Jena, 07607 Eisenberg, Germany. E-mail address for E. Röhner: e.roehner@krankenhaus-eisenberg.de.
authors.forename: Katy
authors.initials: K
authors.lastname: Nuetzmann
authors.affiliation: Orthopaedic Department, Friedrich-Schiller-University, Campus Eisenberg, Klosterlausnitzer Strasse 81, Jena, 07607 Eisenberg, Germany. E-mail address for E. Röhner: e.roehner@krankenhaus-eisenberg.de.
authors.forename: Max
authors.initials: M
authors.lastname: Rau
authors.affiliation: Orthopaedic Department, Friedrich-Schiller-University, Campus Eisenberg, Klosterlausnitzer Strasse 81, Jena, 07607 Eisenberg, Germany. E-mail address for E. Röhner: e.roehner@krankenhaus-eisenberg.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Arnhold
authors.affiliation: Orthopaedic Department, Friedrich-Schiller-University, Campus Eisenberg, Klosterlausnitzer Strasse 81, Jena, 07607 Eisenberg, Germany. E-mail address for E. Röhner: e.roehner@krankenhaus-eisenberg.de.
authors.forename: Georg
authors.initials: G
authors.lastname: Matziolis
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000145:classification / Q000209:etiology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology*; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors