Intramedullary Fixation for Arthrodesis of the Knee After Infected Total Knee Arthroplasty

Abstract

Knee arthrodesis with curved intramedullary rods was performed in 12 patients after infected total knee arthroplasty. The underlying pathologic condition was osteoarthritis in nine patients and rheumatoid arthritis in three patients. Nine patients with a postoperative follow-up time of greater than two years (average, 34 months; median, 29 months; longest, 55 months) were evaluated for functional results. Six patients obtained a satisfactory knee fusion in an average of 6.6 months (range, three to 11 months; median, five months). Those patients without massive bone loss preoperatively attained a fusion rate of 66.6%. Two thirds of the patients with massive bone loss attained fusion. Indications for surgery in addition to infection included massive bone loss, mixed infection with multiple organisms, infrapatellar tendon rupture, ligamentous instability, and severe valgus deformity with tibial fracture nonunion. Failure occurred in three cases. One was associated with rod breakage; another was due to massive bone resorption; and the third was in a diabetic female with infrapatellar tendon rupture. All patients with successful arthrodesis reported an absence of pain and the ability to ambulate with, at most, a walker. The use of curved intramedullary rods is a convenient technique for obtaining successful arthrodesis after infected total knee arthroplasty.