Use of an intramedullary rod in knee arthrodesis following failed total knee arthroplasty

A retrospective review was conducted of 20 consecutive patients (10 men and 10 women) with failed total knee arthroplasty (TKA) who underwent arthrodesis using an intramedullary rod. Average patient age was 70.5 years. One patient was lost to follow-up, and the remaining 19 patients were evaluated an average of 4.5 years postoperatively (range: 1-24 years). Three patients without infections achieved a solid arthrodesis without complications. In 16 patients, the indication for fusion was an infection, and 12 of these patients had an uncomplicated postoperative course and achieved a solid arthrodesis. Of the remaining 4 patients, 1 required revision for a nonunion, 1 a skin graft, and 2 had recurrence of their infections in the postoperative period. Both patients had positive cultures at attempted arthrodesis. One patient underwent debridement at 3 months, and a solid fusion was obtained. The other patient required rod removal and currently has a nonunion, uses a brace, and is on suppressive antibiotic treatment. An intramedullary rod is the ideal fixation choice for knee arthrodesis in patients with a failed, noninfected TKA; however, in patients with an infection, the infection must be eradicated prior to rod use.