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Infected Total Knee Arthroplasty Treated With Arthrodesis Using a Modular Nail

Waldman, Barry, J.*; Mont, Michael, A.*; Payman, K., Rad*; Freiberg, Andrew, A.***; Windsor, Russell, E.; Sculco, Thomas, P.†;; Hungerford, David, S.*

Clinical Orthopaedics and Related Research: October 1999 - Volume 367 - Issue - p 230–237
The Ranawat Award: PDF Only

Failed treatment of infected total knee replacement presents few attractive surgical options. Knee arthrodesis is challenging surgically and can be complicated by nonunion, malunion, or recurrent infection. Recently, a modular titanium intramedullary nail has been used in an attempt to reduce the incidence of nonunion and the rate of complications. In the present study, a review of the results of knee arthrodesis after infected total knee arthroplasty in 21 patients at three large academic institutions was performed. All patients were followed up for a mean of 2.4 years (range, 2–7.5 years). The mean age of the patients was 64 years. The mean number of previous operations was four (range, 2–9 operations). A solid arthrodesis was achieved without additional surgical treatment in 20 of 21 patients (95%). The mean time to fusion was 6.3 months. The one patient who suffered a nonunion achieved fusion after a subsequent bone grafting procedure. Based on the present study, intramedullary arthrodesis with a coupled titanium nail, is a reliable, effective method of achieving fusion after infection of a total knee arthroplasty. This procedure resulted in a high rate of fusion and a lower rate of complications when compared with traditional methods of arthrodesis.

*The Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, Division of Arthritis Surgery at the Good Samaritan Hospital, Baltimore, Maryland

**University of Michigan, Section of Orthopaedic Surgery, University of Michigan Hospitals, Ann Arbor, Michigan

†Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York.

© 1999 Lippincott Williams & Wilkins, Inc.