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. 2007 Feb;3(1):83-8.
doi: 10.1007/s11420-006-9034-z.

Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR

Carl T Talmo  1 , James V Bono, Mark P Figgie, Thomas P Sculco, Richard S Laskin, Russell E Windsor
Affiliations

Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR

Carl T Talmo et al. HSS J. 2007 Feb.

Abstract

Infection is a devastating complication following total knee replacement (TKR). In the majority of cases, single- or two-stage revision has excellent results in eradicating infection and restoring function. Rarely, recurrent infection requires alternative treatments such as resection, amputation, or arthrodesis. A review of infections following TKR treated at two joint replacement centers identified 29 cases of resistant knee sepsis treated with a long intramedullary fusion nail. Clinical outcome and radiographs were reviewed at an average follow-up of 48 months (13-114). After the initial intramedullary arthrodesis union occurred in 24 of 29 patients (83%). The average time to fusion was 6 months (3-18 months). Failures included two cases of nail breakage, one of which subsequently achieved fusion following revision nailing, and three cases of recurrent infection requiring nail removal and permanent resection. At a minimum 2-year follow-up, 28% of the patients that achieved fusion complained of pain in the fused knee, 28% complained of ipsilateral hip pain, and two patients complained of contralateral knee pain. Four of the 25 fused patients (16%) remained nonambulatory after fusion, 17 required walking aids (68%) and only four ambulated unassisted. There was no association between age, number of previous procedures, the use of two-stage versus single stage technique, or infecting organism and failure of arthrodesis. Intramedullary arthrodesis is a viable treatment for refractory infection after TKR. Patients undergoing fusion should be informed of the potential for nonunion, recurrence of infection, pain in the ipsilateral extremity, and the long-term need for walking aids.

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Figures

Fig. 1
Fig. 1
A 69-year-old female with polymicrobial infection of a left TKR and chronic extensor mechanism dysfunction (A) was treated with two-stage intramedullary arthrodesis using a long-locked titanium nail. At 6 months there is evidence of early fusion with partial bridging callous present (B and C). The patient underwent dynamization with removal of the distal interlocks, and at 15 months a solid fusion with bridging trabeculae is present (D)
Fig. 2
Fig. 2
A solid fusion of the knee after intramedullary arthrodesis with the modular Neff nail (Zimmer Co, Warsaw, IN)
See this image and copyright information in PMC

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