title: Knee arthrodesis with a long intramedullary nail as limb salvage for complex periprosthetic infections.
abstract: BACKGROUND
  Periprosthetic infection following total knee arthroplasty is a devastating complication, which is not always satisfactorily resolved by revision surgery. Arthrodesis is a salvage alternative to above-knee amputation or permanent resection arthroplasty. Fixation options include internal compression plating, external fixation, and intramedullary nails.
  
  
  METHODS
  We retrospectively reviewed twelve consecutive cases (9 males, 3 females; mean age, 67 years) of knee arthrodesis with a long intramedullary nail, performed at a single institution between 2003 and 2014. Desired outcomes were the ability to mobilize without pain, solid radiographic fusion, and the eradication of infection.
  
  
  RESULTS
  Mean follow-up was 48.5 months (range, 9-120 months). Eleven patients (92 %) demonstrated stable fusion, ten patients (83 %) were ambulatory without pain, and ten patients (83 %) remained without infection at most recent follow-up. Eight patients (67 %) achieved union at an average of 12 months; three required repeat procedures, achieving union at an average of 9 months. There was a significant difference (P < 0.01) between the numbers of previous operations amongst the eight patients who initially achieved union (mean, 3.25) and three who subsequently required repeat procedures (mean, 8.33).
  
  
  CONCLUSIONS
  In contrast to similar studies, we performed a single-stage exchange where possible, while comparable ambulatory and fusion rates were observed. Numerous previous attempts at revision arthroplasty, co-morbidities, and infections with highly resistant organisms have been associated with further complications. Although technically challenging, knee arthrodesis with a long intramedullary nail offers an acceptable limb salvage procedure for carefully selected patients with complex periprosthetic infections.
authors.affiliation: Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK. nima.razii@doctors.org.uk.
authors.forename: Nima
authors.initials: N
authors.lastname: Razii
authors.affiliation: Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK.|Department of Trauma and Orthopaedics, Wishaw General Hospital, Lanarkshire, UK.
authors.forename: Ammar M I
authors.initials: AM
authors.lastname: Abbas
authors.affiliation: Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kakar
authors.affiliation: Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Cardiff and Vale Orthopaedic Centre, University Hospital Llandough, Cardiff, UK.
authors.forename: Rhidian
authors.initials: R
authors.lastname: Morgan-Jones
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000379:methods; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D023821:Limb Salvage / Q000295:instrumentation / Q000379:methods; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Arthrodesis; Intramedullary nail; Knee arthroplasty; Limb salvage; Periprosthetic infection; Revision