Knee Arthrodesis Using an Intramedullary Nail

doi:10.1016/j.arth.2004.10.015

The Journal of Arthroplasty

Volume 20, Issue 6, September 2005, Pages 703-708

https://doi.org/10.1016/j.arth.2004.10.015 Get rights and content

Abstract

Fifteen knee arthrodeses using an intramedullary nail were performed in 15 patients. Indications included 11 failed total knee arthroplasties (10 of 11 septic). A retrospective review revealed 100% fusion rate. Complications included 4 cases of painful hardware, 1 trochanteric bursitis, and 1 deep infection. Ten patients were available for assessment at 7 years follow-up. Average leg length discrepancy was 3.7 cm. Anatomic axis averaged 1.3° valgus. Flexion angle averaged 3.5°. Compared with age-matched controls, our patients fared significantly worse in physical functioning, physical role, bodily pain, vitality, and social functioning. Arthrodesis of the knee with an intramedullary nail provides a reliable means of fusion with reasonable alignment. These patients have high rates of pain and diminished functional status.

Section snippets

Materials and Methods

After institutional review board approval was obtained, a retrospective review was performed for all patients treated at our institution with intramedullary knee arthrodesis between 1991 and 2000. Fifteen patients were identified whose surgeries were performed by 7 surgeons. The office records and hospital charts were obtained on these patients. Average follow-up was 7 years with a range of 2 to 11 years. There were 9 women and 6 men. Average age at the time of knee arthrodesis was 63 years

Results

Average operating time was 210 minutes. Blood loss averaged 1143 mL. Nine of ten infected total knee arthroplasty failures had staged procedures. One patient with infected total knee was converted to an arthrodesis at the time of the initial debridement (case 13). Twelve nails were locked both proximally and distally. One was locked only proximally, whereas 1 was neither locked proximally nor distally. All femoral and tibial canals were reamed before nail insertion. All knees had the bone ends

Discussion

Several series in the literature show a high rate of fusion when using an intramedullary nail for knee arthrodesis 2, 3, 4, 9, 10, 11, 12, 13, 14, 15, 16, 17. All of our patients with radiographic follow-up had a successful arthrodesis without secondary procedures to promote union. This certainly compares favorably with previous reports. The fact that only failed condylar-type implants were treated in this series could be a contributing factor toward the high fusion rate as hinged implants have

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Cited by (41)

The impact of knee arthrodesis on gait kinematics, muscle activity and patient-reported outcome
2023, Knee
The aim of this retrospective study was to analyze gait kinematics and outcome parameters after knee arthrodesis.
Fifteen patients with a mean follow-up of 5.9 (range 0.8–36) years after unilateral knee arthrodesis were included. A 3D gait analysis was performed and compared to a healthy control group of 14 patients. Comparative electromyography was performed bilaterally at the rectus femoris, vastus lateralis/medialis and tibialis anterior muscles. The assessment further included standardized outcome scores- Lower Extremity Functional Scale (LEFS) and Short Form Health Survey (SF-36).
The 3D analysis showed a significantly shortened stance phase (p = 0.000), an extended swing phase (p = 0.000), and an increased time per step (p = 0.009) for the operated side compared with the nonoperated side. There were statistically significant differences in the extent of movement of the hips, knees and ankles among the operated and nonoperated sides and the control group. For the mean EMG measurement, no significant difference was found between the healthy control group and the patients with arthrodesis. The average LEFS score was 27.5 ± 10.6 out of a maximum of 80 points, and the mean physical total scale and mean emotional total scale scores for the SF-36 were 27.9 ± 8.5 and 52.9 ± 9.9, respectively.
Arthrodesis of the knee joint causes significant kinematic changes in gait pattern, and patients achieve poor results in subjective and functional outcomes (SF- 36, LEFS). Arthrodesis ensures that the extremities are preserved and can enable walking, but it must be viewed as a severe handicap for the patient.
Traumatic periimplant fracture after nail arthrodesis of the knee in a limb reconstruction case
2019, Trauma Case Reports
Citation Excerpt :
Larger Studies as presented by Fenton et al. revealed only one periimplant fracture in 52 patients of tibio-talo-calcaneal nail fusion [5]. Smaller studies do not report any fractures in their series [8]. Hinarejos et al. [4] described one case of periimplant fracture above and below a modular knee arthrodesis nail after a minor fall, which was replaced by a solid custom-made tibiofemoral nail [4].
Many principles of bone reconstruction were successfully applied in this unique case of a 1.92m (6 ft 3 in.) tall 15 year old boy with intercalary leg amputation. This patient suffered from a 26 cm (10.2 in.) bone loss of his left distal femur and severe soft tissue damage with an irreparable extensor mechanism after motor cycle accident.
After periimplant fracture below the knee arthrodesis nail, definite treatment consisted of implant exchange to an 870 mm (34.3 in.) long custom made nail, which is to our knowledge the longest implanted arthrodesis nail in literature.
Therefore the aim of the study was to present our treatment strategies and pitfalls after traumatic periimplant arthrodesis nail fracture in an unusual case of limb reconstruction.
Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency
2017, Knee
Citation Excerpt :
While successful in most patients, complications of this procedure include persistent infection, pain, leg-length discrepancy, and rotational malalignment. To date, the success rate in terms of eradication of infection remains unclear, as there are only few case-series studies published, including patients with and without infection and inconsistent treatment protocols [14–17]. The objective of this study was to evaluate the infection recurrence rate as well as the clinical and functional results in a series of 37 consecutive patients with failed revision TKA, as well as to identify the factors that affect outcomes after surgery.
Periprosthetic joint infection is a serious complication and reconstruction after failed revision total knee arthroplasty with significant bone loss and compromised soft-tissues can be challenging. Objective of this study was to assess clinical and functional results, implant survival and infection recurrence rates in patients treated with two-stage arthrodesis after failed revision TKA with extensor mechanism deficiencies due to PJI, and to identify the factors that affect outcomes after surgery.
Thirty seven patients with PJI treated within a two-stage exchange and reimplantation of an arthrodesis nail between 2008 and 2014 were included. Systemic and local risk factors were graded preoperatively according to McPherson et al. All patients were treated according to a structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford Knee Score and the Visual Analogue Scale.
Thirty two of 37 patients (86.5%) were graded as free of infection. Five patients (13.5%) had recurrent infection after arthrodesis with the need of revision surgery. Mean leg-length discrepancy was 2.2 cm. The mean VAS for pain was three, the mean Oxford Knee Score was 38 ± 9. Total implant survival at a 74 month follow-up was 74.3% (95% CI: 45.4 to 91.1%), as determined by Kaplan–Meier survival curves. Local McPherson Score, as well as number of revisions was found to be of significant influence to the survival rate.
Septic failure of revision knee arthroplasty can be effectively treated with two-stage arthrodesis using a modular intramedullary nail, providing a stable and painless limb with satisfactory functional results and acceptable infection eradication rates.
The multiply operated total knee patient: When enough is enough
2015, Seminars in Arthroplasty JSES
The multiply operated TKA patient presents unique challenges. Careful preoperative evaluation can facilitate the selection of the appropriate reconstructive strategy. Amputation, arthrodesis, definitive resection, or further attempts at prosthetic reconstruction all have unique advantages and disadvantages. The patient's functional demands, medical co-morbidities, and the status of the limb can guide treatment decisions.
No improvement in the post-TKA infection prognosis when the implant is not reimplanted: Retrospective multicentre study of 72 cases
2015, Revue de Chirurgie Orthopedique et Traumatologique
La dépose définitive d’une prothèse de genou infectée est le plus souvent ressentie par le chirurgien et le patient comme une solution contrainte imposée par des conditions locales ou générales défavorables, faisant craindre un échec mécanique ou infectieux de la réimplantation. Le but de cette étude était de vérifier si la dépose définitive d’une prothèse totale de genou (PTG) infectée lorsque la réimplantation s’avère trop risquée, permettait de contrôler l’infection et d’éviter l’amputation de cuisse. L’hypothèse était que la dépose sans réimplantation favorise l’éradication de l’infection et permet d’éviter l’amputation.
Soixante-douze patients opérés consécutivement d’une dépose de PTG entre 2000 et 2010 dans 14 centres ont été revus. La dépose était suivie d’une arthrodèse dans 33 cas ou de l’implantation d’un espaceur acrylique définitif dans 39 cas.
En prenant pour critère d’échec la récidive infectieuse patente cliniquement, le taux de survie était de 65 % ± 5 % à deux ans, 44 % des patients ayant présenté une récidive infectieuse, 8 % ayant été amputés, 19 % étant en pseudarthrodèse au dernier recul. Les facteurs d’échecs étaient le sexe masculin et la présence de plusieurs comorbidités.
Le contrôle de l’infection n’est pas garanti par la dépose de l’implant, avec un taux de succès inférieur aux réimplantations en deux temps. Nos résultats sont inférieurs à ceux de la littérature. L’hétérogénéité des patients et des traitements ainsi que l’association des comorbidités peuvent être une explication. Cette option thérapeutique est à considérer en dernier recours avant l’amputation.
Niveau IV étude rétrospective de cohorte.
No improvement in the post-TKA infection prognosis when the implant is not reimplanted: Retrospective multicentre study of 72 cases
2015, Orthopaedics and Traumatology: Surgery and Research
For the surgeon and patient, permanent removal of an infected knee prosthesis is an unwelcome decision taken out of necessity because unfavourable local or general conditions may increase the likelihood of mechanical or infectious failure upon prosthesis reimplantation. The purpose of this study was to determine if permanent removal of an infected total knee arthroplasty (TKA) implant controls the infection and prevents above-the-knee amputation when reimplantation turns out to be too risky. It was hypothesized that removal without reimplantation contributes to eradicating the infection and helps to avoid amputation.
Seventy-two consecutive patients who underwent TKA removal between 2000 and 2010 at 14 hospitals were reviewed. The TKA removal was followed by knee fusion in 29 cases or implantation of a permanent cement spacer in 43 cases.
If failure is defined as clinically obvious recurrence of the infection, the survival rate was 65 ± 5% at 2 years; 44% of patients had a recurrence of the infection, 8% had undergone amputation and 19% presented with nonunion at the last follow-up. The male gender and the presence of multiple co-morbidities were predisposing factors for failure.
Control of the infection is not guaranteed upon TKA implant removal; the success rate is lower than in cases of two-stage reimplantation. The outcomes in this study are worse than those of other published studies. This is likely due to the heterogeneity in the patient population and treatments, along with the presence of co-morbidities. This treatment option should be the last recourse before amputation.
Level IV, Retrospective cohort study.

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Original ArticleKnee Arthrodesis Using an Intramedullary Nail

Abstract

Section snippets

Materials and Methods

Results

Discussion

J Arthroplasty

J Arthroplasty

Arthrodesis of the ankle, knee, and hip

Arthrodesis following failed total knee arthroplasty: comprehensive review and meta-analysis of recent literature

Orthopedics

Knee arthrodesis in the treatment of failed total knee replacement

Clin Orthop

SF-36 health survey, manual and interpretation guide

Rationale of the knee society clinical rating system

Clin Orthop

Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming

J Bone Joint Surg Am

Use of an interlocked cephalomedullary nail for subtrochanteric fracture stabilization

Clin Orthop

Original Article
Knee Arthrodesis Using an Intramedullary Nail