Abstract
Knee arthrodesis is a potencial salvage procedure for limb preservation in patients with multiple failures of Total Knee Arthroplasty (TKA) with massive bone loss and extensor mechanism deficiency.
The purpose of the study is to evaluate the outcome of bridging knee arthrodesis using a modular and non cemented intramedullary nail in patients with septic failure Total Knee Arthroplasty.
Between 2005 and 2013 (9 years), 15 patients (13 female and 2 male) with mean age 71.1 years (range 41 to 85) were treated at our Institution with septic two- stage knee arthrodesis using a modular and non- cemented intramedullary nail after multiple failures of septic Total Knee Arthroplasty.
Mean follow- up was 70.1 months (24 to 108 months) with a minimum follow- up of 24 months.
We evaluated the erradication of infection clinically and with normalization of laboratory parameters (ESR and CRP), limb length discrepancies and complications (periimplant fractures, amputation rates, wound healing disturbances) and the subjective evaluation of the patients after knee arthrodesis.
We reported 11 cases of resolution of the infection (73.3 %), with good tolerance of the implant and a mean limb length discrepancies of 15 mm.
Of these, 8 patients had been monitored over 5 years without recurrence of the infection.
The mean number of previous operations was 4.9 (range 2 to 9).
Two patients (13.3 %) required multiples surgical debridements for uncontrolled sepsis and finally underwent knee amputation.
Coagulase- negative Staphylococci (SCN) were the most commom pathogen (53.3 %) followed by polimicrobian infections (26.7 %)
One patient continues suppressive antibiotic treatment and 1 patient was treated with a one- stage custom- made arthrodesis nail exchange.
Bridging knee arthrodesis using a modular and non- cemented intramedullary nail is a salvage procedure with acceptable results in terms of erradication of infection after septic faliure Total Knee Arthroplasty with restoration of limb length discrepancy.
Despite these satisfactory results it is not without serious complications such as knee amputation.
