Knee arthrodesis using a custom modular intramedullary nail in failed, infected knee arthroplasties: A concise follow-up note of 31 cases at a median of 13 years post-arthrodesis

2021 ◽  
pp. 102898 ◽  
Author(s):  
Philippe-Alexandre Faure ◽  
Sophie Putman ◽  
Eric Senneville ◽  
Eric Beltrand ◽  
Héléne Behal ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Knee Arthrodesis

The results of knee arthrodesis with dedicated modular intramedullary nail as a limb salvage procedure in infection complications of knee arthroplasty

2020 ◽  
Vol 86 (2) ◽  
pp. 33-38
Author(s):  
Marcin Para ◽  
◽  
Paweł Bartosz ◽  
Maciej Kogut ◽  
Gracjan Suchodolski ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Intramedullary Nail ◽  
Oxford Knee Score ◽  
Knee Score ◽  
Knee Arthrodesis ◽  
Bone Contact ◽  
Total Knee ◽  
The Mean

Introduction. Complications after arthroplasty often result in irreversible disability. In some cases, for the extremity to be salvaged, permanent knee joint arthrodesis is a last-chance procedure. Modular implant design simplifies surgical technique and knee arthrodesis without bone-on-bone contact, immediately provides full weight bearing and restores limb length and alignment. Puropose. The aim of this article was to perform a clinical evaluation of patients after knee arthrodesis with a dedicated modular intramedullary nail without bone-on-bone contact after a failed infected total knee arthroplasty. Methods. Between 2017 and 2021, 17 patients were treated with knee arthrodesis with a modular nail after a septic complication of total knee arthroplasty. Clinical evaluation of 15 patients was obtained during a follow-up visit, including: the pain severity using the Visual Analog Scale (VAS), physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score, gait independence, and the shortening of the affected limb in relation to the other one. Results. The mean follow-up duration was 1.4 years. The group included 11 women and 4 men with an average of 69.3 (57–84) years. All nails were cemented. There was one recurrence of infection. The mean VAS pain score was 2.73, also 4 patients felt no pain at all. The average functional score on the WOMAC scale was 36.4 (14–60) and for the Oxford Knee Score was 26.5 (15–41). Each patient achieved an independent gait. All patients reported the necessity of use of crutches outside home. The average limb shortening was 2.05 cm (0.5–3.0). In addition, 14 of the 15 patients positively evaluated the procedure results and if they had to, they would again decide on this form of treatment. During follow-up, no complication or problems with implants used were observed. Conclusions. Knee arthrodesis with modular nail offers an acceptable functional result and gives a chance of salvaging a limb in complex septic complications of TKA.

scholarly journals Intramedullary reaming modality for management of postoperative long bone infection: a prospective randomized controlled trial in 44 patients

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Carlos Augusto Finelli ◽  
Fernando Baldy dos Reis ◽  
Helio Alvachian Fernandes ◽  
Adriana Dell’Aquila ◽  
Rogério Carvalho ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Controlled Trial ◽  
Long Bone ◽  
Cement Spacer ◽  
Coagulase Negative Staphylococci ◽  
Radiological Criteria ◽  
Intramedullary Reaming ◽  
Prospective Randomized Controlled Trial ◽  
Retrograde Nail

Abstract Background Studies addressing the management of intramedullary infection are mainly retrospective and with a limited number of cases. Reaming can be performed using either conventional reaming or using the reamer/irrigator/aspirator (RIA) system. Until now there have been no comparative prospective studies between these two methods. We aimed to compare the efficacy of RIA with conventional reaming followed by insertion of antibiotic-loaded cement, for the treatment of intramedullary nail infection of long bones. We assessed the rate of remission between groups after two-year follow-up and identified microorganisms using tissue cultures and sonication of explanted intramedullary nail (IMN). Methods A noninferiority, randomized clinical trial was carried out between August 2013 and August 2015 involving 44 patients of whom a locked IMN implant of the femur and/or tibia was retrieved and who all met the clinical and radiological criteria for IMN-associated osteomyelitis. Patients were randomized into two groups: RIA alone versus conventional reaming followed by antibiotic-loaded cement insertion. Both groups also underwent six-weeks of antibiotic treatment according to the results of the antibiogram. Patients were evaluated after 1, 3, 6, 12 and 24 months for radiological and clinical follow-up. Results After 24 months, the rate of infection remission was similar between the two groups, 87% in the RIA group and 95.5% in the conventional reaming group (p = 0.60). Among four patients who had recurrence of infection, the time to reappearance of symptoms varied from 20 days to twenty-two months. Staphylococcus aureus and coagulase-negative Staphylococci were isolated in 23 (40.4%) and 13 (22.9%) patients, respectively. Interestingly, we identified 20% (9/45) of polymicrobial infection. Conclusion This study concludes that the RIA system alone, is noninferior to conventional reaming followed by antibiotic cement spacer in the treatment of IMN infection. However, RIA shows greater efficacy in the collection of infected medullary bone tissue, mainly in cases of infected retrograde nail of the femur. Trial registration ISRCTN82233198. Retroactively registered on July 29, 2019.

scholarly journals Ten-Year Follow-Up of Desarthrodesis of the Knee Joint 41 Years after Original Arthrodesis for a Bone Tumor

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Ahmed Hamed Kassem Abdelaal ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
Shinji Miwa ◽  
...  
Keyword(s):  
Knee Joint ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Tumor Resection ◽  
Cell Tumor ◽  
Joint Surface ◽  
Knee Arthrodesis ◽  
Extensive Resection ◽  
Complication Risk

Introduction. The main indication for knee arthrodesis in tumor surgery is a tumor that requires an extensive resection in which the joint surface cannot be preserved. We report a patient that had knee desarthrodesis 41 years after giant cell tumor resection followed by a knee arthrodesis. This is the longest reported follow-up after desarthrodesis and conversion to total knee arthroplasty (TKA), almost ten years.Case Report. A 71-year-old man with a distal femoral giant cell tumor had undergone a resection of the distal femur and knee arthrodesis using Kuntscher nail in 1962. In July 2003 he experienced gradually increasing pain of his left knee. We performed a desarthrodesis and conversion to TKA in 2005. The postoperative period passed uneventfully as his pain and gait improved, with gradually increasing range of motion (ROM) and no infection. He now walks independently, with no brace or contractures.Conclusion. Desarthrodesis of the knee joint and conversion to TKA are a difficult surgical choice with a high complication risk. However, our patient’s life style has improved, he has no pain, and he can ascend and descend stairs more easily. The surgeon has to be very meticulous in selecting a patient for knee arthrodesis and counseling them to realize that their expectations may not be achievable.

Two-stage arthrodesis for complex, failed, infected total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 170-175
Author(s):  
Brian P. Chalmers ◽  
Alexis K. Matrka ◽  
Stephen A. Sems ◽  
Matthew P. Abdel ◽  
Rafael J. Sierra ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
External Fixator ◽  
Persistent Infection ◽  
Drug Resistant ◽  
Knee Arthrodesis ◽  
Two Stage ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee ◽  
Flap Cover

Aims Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients. Methods We retrospectively identified 41 patients (41 TKAs) with a complex infected TKA, who were treated between 2002 and 2016 using a deliberate, two-stage knee arthrodesis. Their mean age was 64 years (34 to 88) and their mean body mass index (BMI) was 39 kg/m2 (25 to 79). The mean follow-up was four years (2 to 9). The extensor mechanism (EM) was deficient in 27 patients (66%) and flap cover was required in 14 (34%). Most patients were host grade B (56%) or C (29%), and limb grade 3 (71%), according to the classification of McPherson et al. A total of 12 patients (29%) had polymicrobial infections and 20 (49%) had multi-drug resistant organisms; fixation involved an intramedullary nail in 25 (61%), an external fixator in ten (24%), and dual plates in six (15%). Results Survivorship free from amputation, persistent infection, and reoperation, other than removal of an external fixator, at five years was 95% (95% confidence interval (CI) 89% to 100%), 85% (95% CI 75% to 95%), and 64% (95% CI 46% to 82%), respectively. Reoperation, other than removal of an external fixator, occurred in 13 patients (32%). After the initial treatment, radiological nonunion developed in ten knees (24%). Nonunion was significantly correlated with persistent infection (p = 0.006) and external fixation (p = 0.005). Of those patients who achieved limb salvage, 34 (87%) remained mobile and 31 (79%) had ‘absent’ or ‘minimal’ pain ratings. Conclusion Knee arthrodesis using a two-stage protocol achieved a survivorship free from amputation for persistent infection of 95% at five years with 87% of patients were mobile at final follow-up. However, early reoperation was common (32%). This is not surprising as this series included worst-case infected TKAs in which two-thirds of the patients had a disrupted EM, one-third required flap cover, and most had polymicrobial or multi-drug resistant organisms. Cite this article: Bone Joint J 2020;102-B(6 Supple A):170–175.

scholarly journals Retrograde Intramedullary Nail Fixation for Derotational Femoral Osteotomy for Recurrent Femoropatellar Instability

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Maximiliano Barahona ◽  
Alvaro Zamorano ◽  
Cristian Barrientos ◽  
Mauricio Guzmán ◽  
Yoshiro Sato ◽  
...  
Keyword(s):  
Intramedullary Nail ◽  
Femoral Osteotomy ◽  
Fixation Method ◽  
Functional Score ◽  
Femoral Torsion ◽  
Stability Problems ◽  
Retrograde Intramedullary Nail ◽  
Femoral Nail ◽  
Derotational Osteotomy

Axial alignment of the femur and tibia is often misdiagnosed in patients with patellofemoral stability problems. Femoral torsion is critical for patellofemoral biomechanics, so it must be evaluated in every patient before the plan of surgery is decided. This case describes a femoral derotational osteotomy due to excessive internal torsion of the femur fixed with a retrograde femoral nail. This type of fixation provides a biomechanical advantage compared to plates. At the two-year follow-up, the patient achieved excellent results, reaching a functional score of 91 points on the Lysholm scale. Derotational femoral osteotomy should be considered in patellofemoral pathology, and a retrograde femoral nail is a valid fixation method for this surgery.

Follow-up study of ankle arthrodesis in severe hind foot deformity in patients with rheumatoid arthritis using an intramedullary nail with fins

2005 ◽  
Vol 15 (4) ◽  
pp. 269-274 ◽  
Author(s):  
Masakazu Nagashima ◽  
Akitoshi Tachihara ◽  
Tsuyoshi Matsuzaki ◽  
Kenji Takenouchi ◽  
Juhro Fujimori ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Intramedullary Nail ◽  
Ankle Arthrodesis ◽  
Foot Deformity ◽  
Follow Up Study ◽  
Hind Foot

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

2018 ◽  
Vol 12 (1) ◽  
pp. 554-566
Author(s):  
Malcolm R. DeBaun ◽  
Stuart B. Goodman ◽  
David W. Lowenberg
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Retrospective Case ◽  
Total Knee

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.

scholarly journals Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

2020 ◽  
Author(s):  
Hong-An Zhang ◽  
Chun-Hao Zhou ◽  
Xiang-Qing Meng ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Intramedullary Nailing ◽  
Distraction Osteogenesis ◽  
Intramedullary Nail ◽  
Calcium Sulfate ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Bone Transport ◽  
Complication Rates ◽  
Nail Removal

Abstract Background: The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods: We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results: A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion: Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

scholarly journals Tibiotalocalcaneal Fusion Rate with a Novel Pseudoelastic Intramedullary Nail with NiTiNOL

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004
Author(s):  
Travis Dekker ◽  
John Steele ◽  
Beau Kildow ◽  
James DeOrio ◽  
Mark Easley ◽  
...  
Keyword(s):  
High Risk ◽  
Bone Resorption ◽  
Intramedullary Nail ◽  
Fusion Rate ◽  
High Risk Population ◽  
Risk Population ◽  
Non Union ◽  
Significant Difference ◽  
History Of

Category: Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion is a salvage operation for patients with significant arthritis and deformity of ankle and subtalar joints. Despite overall clinic success, fusion across both joints continues to be a major challenge with nonunion rates reported up to 48% [Franceschi]. Aside from certain patient comorbidities, nonunion may result when compression across the joint is lost in the setting of bone resorption. The use of a pseudoelastic intramedullary nail has been shown to maintain compression across fusion site in response to bone resorption. The purpose of this study was to evaluate the fusion rate in a high-risk population at a tertiary care center using a psuedoelastic intramedullary nail with an internal nitinol element. Methods: After obtaining IRB approval, a retrospective review of consecutive patients that underwent procedures with TTC fusion with novel intramedullary nail system with super elastic internal nickel titanium (NiTiNOL, DynaNail, Medshape Inc, Atlanta, GA) was performed at a single academic institution. From 2014 to 2016, 58 patients were identified, 55 of which had minimum one year follow up or clinical and radiographic fusion (20 months average, range 6-41 months). The primary outcome was radiographic fusion analysis which was reviewed by three authors. Fusion was determined by consensus with criteria of 3 of 4 cortices with osseous bridging in asymptomatic patients[1, 2] or CT fusion based on Glazebrook et. al. criteria for hindfoot fusion[3, 4]. Average age of this cohort was 59 (SD= 16.3) years with BMI average 33.1 (SD= 8.87). Exclusion criteria include: follow-up less than 12 months in non-fused patients, and incomplete clinical or radiologic data. Results: The fusion rate in this high-risk population was 80.0% with the use of the NiTiNOL tibiotalocalcaneal nailing system. Univariate analysis demonstrated no significant difference (p>0.05) in fusion rates with patient comorbidities that portend to non-union: current or former history of tobacco use, diabetes mellitus, rheumatoid arthritis, nor patients with chronic kidney disease. The average BMI in the fusion group was 31.97 compared to 27.4 in the non-union group (p=0.016). There were 5 deep infections requiring reoperation with a single patient requiring a below the knee amputation. Seven patients required a second operation for removal of prominent interlocking screws. Conclusion: This preliminary data demonstrates fusion rates with this novel intramedullary device are consistent with historical data. These findings are encouraging in that this nailing system shows equal rates of fusion in patients with high risk comorbidities for non-union compared to historical controls demonstrating increased non-union rates in diabetics, patients with chronic renal failure and those with a history of smoking. This Tibiotalocalcaneal nailing system is safe and offers theoretical sustained compression with up to 6 mm of resorption or settling.

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