title: Can a Silver-Coated Arthrodesis Implant Provide a Viable Alternative to Above Knee Amputation in the Unsalvageable, Infected Total Knee Arthroplasty?
abstract: In the unsalvageable, infected total knee arthroplasty, knee arthrodesis is one treatment option with lower reported reinfection rates compared with repeated 2-stage revision and improved function compared with amputation. One possible method for reducing incidence of recurrent infection treated by arthrodesis is the use of a silver-coated implant. We report our experience of silver-coated arthrodesis nails used for managing infected revision arthroplasty. We primarily assess the rate of reinfection and rate of amputation and report functional outcome measures.
  
  
  
  Retrospective analysis of all patients undergoing knee arthrodesis with a silver-coated arthrodesis nail between 2008 and 2014. Patient-reported data were recorded prearthrodesis and postarthrodesis (Oxford Knee Score and Short Form-36) as well as evidence of recurrent of infection, subsequent surgery, and the necessity for amputation.
  
  
  
  Eight patients underwent arthrodesis using the silver-coated arthrodesis nail. Mean duration of follow-up was 16 months (5-35 months). At the point of follow-up, there were no amputations, deaths, or implant revisions. One case of recurrent infection was successfully treated with washout and debridement. The mean prearthrodesis and postarthrodesis Oxford Knee Score difference was +8.9 points (P = .086) with significantly improved pain (P = .019), night pain (P = .021), and ease of standing (P = .003).
  
  
  
  Arthrodesis of the knee using a silver-coated intramedullary device is successful in eradicating infection and allowing limb conservation. Where infection does recur, this can be successfully treated with implant retention. The use of a silver-coated arthrodesis nail should be considered as an alternative to amputation for patients with a multiply revised and infected total knee arthroplasty.
authors.affiliation: Royal Orthopaedic Hospital, Birmingham, West Midlands, United Kingdom.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Wilding
authors.affiliation: Royal Orthopaedic Hospital, Birmingham, West Midlands, United Kingdom.
authors.forename: George A
authors.initials: GA
authors.lastname: Cooper
authors.affiliation: Royal Orthopaedic Hospital, Birmingham, West Midlands, United Kingdom.
authors.forename: Alexandra K
authors.initials: AK
authors.lastname: Freeman
authors.affiliation: Royal Orthopaedic Hospital, Birmingham, West Midlands, United Kingdom.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Parry
authors.affiliation: Royal Orthopaedic Hospital, Birmingham, West Midlands, United Kingdom.
authors.forename: Lee
authors.initials: L
authors.lastname: Jeys
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001174:Arthrodesis / Q000009:adverse effects / Q000295:instrumentation*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001858:Bone Nails; D003646:Debridement / Q000009:adverse effects; D005260:Female; D005270:Femur Head / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects; D023821:Limb Salvage / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012834:Silver / Q000627:therapeutic use*; D017211:Treatment Failure; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D012834:Silver
keywords: arthrodesis; coating; infection; knee; silver