Technique of extracting a compression intramedullary nail that preserves knee arthrodesis

Abstract

Intramedullary compression nails have recently been developed for knee arthrodesis. These implants have given fusion in 90–100% of cases regardless of the initial diagnosis or experience of the user (Domingo et al. 2004, McQueen et al. 2006, De et al. 2008). However, many clinicians have been reluctant to use this technique due to the perceived difficulty in or impossibility of removing these nails without disrupting the fusion, to allow the management of associated complications such as infection. We present the case of a patient who required removal of a compression intramedullary fusion nail for recurrent infection, in order to describe an easily performed extraction technique that does not disrupt the arthrodesis and that allows definitive management of infection. A 48-year-old man was referred with a painful failed knee arthrodesis that had originally been attempted for failed primary knee arthroplasty secondary to infection. There were no clinical or hematological signs of residual infection, so we proceeded to attempt fusion with an intramedullary compression nail (Wichita Fusion Nail; Stryker). He developed recurrent infection, which was managed with appropriate antibiotics until solid fusion was achieved. We then proceeded to remove the nail 8 months after the fusion procedure and to manage the infection more definitively (Figure 1). Figure 1. A. 8 months after fusion. B. 1 month after nail removal.