Cement Arthrodesis of the Knee with a Custom Long Recon Nail After Failed Total Knee Arthroplasty: Surgical Technique and Results



Malcolm R. DeBaun, Stuart B. Goodman, David W. Lowenberg*
Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street Redwood City, CA 94063, USA

Abstract

Background and Objective:

Persistent periprosthetic joint infection (PJI) is a devastating complication after total knee arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss.

Methods:

In a retrospective case series, 15 consecutive patients who underwent knee arthrodesis after failed ipsilateral TKA secondary to infection from 2004-2017 with at least 1 year of follow-up were enrolled. The average age of patients at the time surgery was 68 (range 50-81) years with an average follow-up of 3.2 (range 1-6) years. Post-surgical ambulation status and eradication of index infection were analyzed as primary outcomes using McNemar’s test for before-and-after study design with p<0.05 for significance.

Results:

Cement arthrodesis significantly improved ambulation with 67% (10/15) of patients unable to ambulate before arthrodesis and 93% (14/15) of patients able to ambulate at final follow-up (p=0.004). The complication rate was 20% (3/15). There were no periprosthetic fractures. Amongst patients who presented with active PJI, 91% (10/11) had eradication of their index infection final follow-up (p=0.002). Overall prevention of recurrent index infection was 93% (14/15) (p=0.0001).

Conclusion:

Cement arthrodesis utilizing a custom knee spanning recon nail combined with an antibiotic eluting spacer improves ambulation status and prevents or treats recurrent infection in the majority of patients who have failed total knee arthroplasty.

Keywords: Cement Arthrodesis, Knee Fusion, Knee Arthrodesis, Failed Total Knee Arthroplasty, Failed TKA.


Abstract Information


Identifiers and Pagination:

Year: 2018
Volume: 12
Publisher Item Identifier: EA-TOORTHJ-2018-46

Article History:

Received Date: 7/8/2018
Revision Received Date: 14/11/2018
Acceptance Date: 15/11/2018
Electronic publication date: 26/11/2018
Collection year: 2018

© 2018 DeBaun et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Correspondence: Address correspondence to this author at the Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street Redwood City, CA 94063, USA; Tel: 650-721-7669; E-mail: lowenbd@stanford.edu