Arthrodesis After Infected Revision TKA: Retrospective Comparison of Intramedullary Nailing and External Fixation

HSS Journal: Volume 9 Issue 3

Iacono Francesco, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy

Raspugli Giovanni Francesco, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy

Bruni Danilo, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy

Lo Presti Mirco, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy

Sharma Bharat, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy

Akkawi Ibrahim, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy

Marcacci Maurilio, MD,
Biomechanics Laboratory, Rizzoli Orthopaedics Institute, Italy


Abstract

Background:
Infection after revision total knee arthroplasty (TKA) for previous septic TKA can be a challenging problem to treat due to loss of bone stock and soft tissue integrity. In these cases, arthrodesis is a well-recognized salvage procedure.

Questions/Purposes:
The aim of this retrospective study was to compare the results as described by a Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score (LAS) of knee arthrodeses performed by using either an external fixator (EF) or an intramedullary nail (IM).

Methods:
The study included 34 knee arthrodesis divided in two groups: first group included 12 patients treated with EF and the second group of 22 patients dealt with IM nail. Clinical and functional evaluation was performed using the VAS and the LAS. Full-length radiographs were used to verify limb length discrepancy.

Results:
VAS and LAS results showed a substantial improvement relative to preoperative condition in both groups. However, the LAS was significantly better in the IM nail group. The mean leg length discrepancy was significantly greater (4.5 cm) in the first group than in the second one (0.8 cm). No recurrence of infection was observed in the EF group while there were three recurrent infections in the IM nail group.

Conclusion:
Our study supported the existing literature and found that reinfection after revision TKA can be effectively treated with arthrodesis. In presence of massive bone loss, we recommend arthrodesis with IM nail used as an endoprosthesis, without bone-on-bone fusion, to produce a stable and painless knee, while preserving the limb length. Use of an IM nail allowed us to get a better functional result than EF.

Level of Evidence:
Therapeutic Study Level III. See levels of evidence for a complete description.

This article appears in HSS Journal: Volume 9 Issue 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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