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Knee Arthrodesis With an Intramedullary Antegrade Rod as a Salvage Procedure for the Chronically Infected Total Knee
Nicholas M Brown1, Rishi Balkissoon, Bryan M Saltzman
1From the Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL (Dr. Brown); the Department of Orthopaedic Surgery, University of Rochester Medical Center, Orthopaedics & Rehabilitation, Rochester, NY (Dr. Balkissoon); OrthoCarolina, Sports Medicine Center, Atrium Health Musculoskeletal Institute (MSKI), Charlotte, NC (Dr. Saltzman); Anchorage Fracture & Orthopedic Clinic, Anchorage, AK (Dr. Haughom); UCSF Fresno, Fresno, CA (Dr. Li); the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Levine); and the Department of Orthopaedic Surgery, Cadence Health, Winfield, IL (Dr. Sporer).
Introduction:
Infection is a challenging complication after total knee arthroplasty (TKA) that is often treatable. However, recurrent infection may require resection, amputation, or arthrodesis. The purpose of this study was to evaluate the results of antegrade nailing with an intramedullary rod for the treatment of a chronically infected TKA.
Methods:
This study was a retrospective review of a consecutive series of 18 patients with chronically infected TKA treated with arthrodesis using a long antegrade intramedullary nail. There were 11 women and 7 men with an average age of 65 years and average body mass index of 33.8 kg/m. Patients had an average of 7.4 procedures before fusion, and mean follow-up was 50 months. One patient died in the early postoperative period, leaving 17 patients for evaluation. Fusion was defined radiographically as bony bridging of the joint surfaces visible on both anterior-posterior and lateral radiographs. Ambulatory ability, need for chronic antibiotic suppression, complications, and nail removal were recorded.
Results:
Sixteen of 17 patients (94%) underwent successful fusion. Ten of 17 patients (59%) continued to ambulate with 9 of these patients requiring an assist device and 7 of 17 patients (41%) predominantly used a wheelchair. Chronic antibiotic suppression was used in 13 of 17 patients (76%). Two patients required nail removal (one for pseudarthrosis and one for possible total hip arthroplasty) and overall 8 of 17 patients (47%) had a complication. Six of 18 patients (33%) died within 2 years of their fusion procedure.
Discussion:
Knee arthrodesis with an antegrade intramedullary nail is a viable treatment option for the chronically infected TKA. There was a high rate of successful fusion, along with a high rate of complications, mortality, and need for chronic antibiotic suppression.
Conclusion:
Knee arthrodesis with a long IMN is a suitable treatment method as salvage for a chronically infected TKA, but patients should be counseled on the high rate of postoperative complications, poor ambulatory rate, likely need for suppressive antibiotics, and high mortality rate.
