title: Knee arthrodesis with modular nail after failed TKA due to infection.
abstract: BACKGROUND
  Knee arthrodesis is an established procedure for limb salvage after failed total knee arthroplasty (TKA) in cases of recurrent infection, soft tissue damage, reduced bone stock or with a deficient extensor mechanism. Walking with an arthrodesis is more efficient and less costly in terms of energy expenditure than above-knee amputation. Surgical options include an arthrodesis nail, external fixator or compression plate. We present our results of knee arthrodesis using the modular Wichita Fusion Nail(®) in patients after infected TKA.
  
  
  METHODS
  Fifteen patients with irretrievably failed TKA, due to infection, who underwent arthrodesis with the Wichita Fusion Nail(®) from 2004 to 2012 were retrospectively reviewed to assess fusion rate, time to fusion, complication rate, including new infections, and ambulatory status.
  
  
  RESULTS
  Three patients were lost to follow-up. Mean follow-up was 33 months (6-132 months). At their most recent follow-up, all patients were walking with full weight bearing on a fused arthrodesis. Mean time to union was 9 months (3-29 months). Three patients necessitated a revision arthrodesis to achieve union after a mean of 5 months after the last procedure.
  
  
  CONCLUSIONS
  Arthrodesis with the Wichita Fusion Nail(®) provides satisfactory results in patients with failure after infected TKA, with 75 % primary union rate and no new or persistent infection at last follow-up visit. Although burdened with a high complication rate, it represents an acceptable option for limb salvage in this particular pathology.
authors.affiliation: Département de l'appareil locomoteur, Centre Hospitalier Universitaire Vaudois, Service d'orthopédie et traumatologie, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. nicolas.gallusser@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gallusser
authors.affiliation: Département de l'appareil locomoteur, Centre Hospitalier Universitaire Vaudois, Service d'orthopédie et traumatologie, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Goetti
authors.affiliation: Département de l'appareil locomoteur, Centre Hospitalier Universitaire Vaudois, Service d'orthopédie et traumatologie, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Anais
authors.initials: A
authors.lastname: Luyet
authors.affiliation: Département de l'appareil locomoteur, Centre Hospitalier Universitaire Vaudois, Service d'orthopédie et traumatologie, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. olivier.borens@chuv.ch.
authors.forename: Olivier
authors.initials: O
authors.lastname: Borens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001858:Bone Nails; D006801:Humans; D008875:Middle Aged; D009262:Nails; D016459:Prosthesis-Related Infections / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016879:Salvage Therapy / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology
keywords: Infected TKA; Knee arthrodesis; Modular nail