Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Orthopaedics
Published in: International Orthopaedics 2/2014

01-02-2014 | Original Paper

Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results

Authors: Sara Scarponi, Lorenzo Drago, Delia Romanò, Nicola Logoluso, Andrea Peccati, Enzo Meani, Carlo L. Romanò

Published in: International Orthopaedics | Issue 2/2014

Login to get access

Abstract

Purpose

Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA).

Methods

Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes.

Results

Spacer exchange was necessary for infection persistence in one case. At a minimum two year follow-up, 34 patients (89.5 %) showed no infection recurrence; among these 34 patients, 29 (85.3 %) reported no or moderate pain [visual analogue scale (VAS) ≤3]; mild to moderate handicap (Lequesne Algofunctional Index < 7.5) was observed in 18 patients (52.9 %). No patient underwent revision for aseptic loosening, and no nail breakage was observed.

Conclusions

Two-stage cementless intramedullary nailing without achieving bone-to-bone fusion is a viable option for treating chronically infected TKA in selected, complex cases.
Literature
1.
Goyal N, Miller A, Tripathi M, Parvizi J (2013) Methycillin-resistant Staphylococcus aureus (MRSA). Colonization and pre-operative screening. Bone Joint J 95B:4–9CrossRef
2.
Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP et al (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51PubMedCrossRef
3.
Montanaro L, Speziale P, Campoccia D, Ravaioli S et al (2011) Scenery of Staphylococcus implant infections in orthopedics. Future Microbiol 6:1329–1349PubMedCrossRef
4.
Trampuz A, Widmer AF (2006) Infections associated with orthopedic implants. Curr Opin Infect Dis 19:349–356PubMedCrossRef
5.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedCrossRef
6.
Parvizi J, Zmistowski B, Adeli B (2010) Periprosthetic joint infection: treatment options. Orthopedics 33:659PubMed
7.
Romanò CL, Gala L, Logoluso N, Romanò D, Drago L (2012) Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc. doi:10.​1007/​s00167-012-1885-x PubMed
8.
Conway DJ, Mont MA, Bezwada HP (2004) Arthrodesis of the knee. Current concepts review. J Bone Joint Surg Am 86-A:835–848PubMed
9.
Nelson CL, Evarts CM (1971) Arthroplasty and arthrodesis at the knee. Orthop Clin N Am 2(2):245–264
10.
Rand JA, Bryan RS, Chao EYS (1987) Failed total knee arthroplasty treated by arthrodesis of the knee using the Ace-Fischer apparatus. J Bone Joint Surg 69A:39–45
11.
Damron TA, McBeath AA (1995) Arthrodesis following failed total knee arthroplasty: comprehensive review and meta-analysis of recent literature. Orthopedics 18:361–368PubMed
12.
Oostenbroek HJ, VanRoermund PM (2001) Arthrodesis of the after an infected arthroplasty using the Ilizarov method. J Bone Joint Surg Am 83:50–54CrossRef
13.
Wiedel JD (2002) Salvage of infected total knee fusion: the last option. Clin Orthop Relat Res 404:139–142PubMedCrossRef
14.
Hanssen AD, Spangehl MJ (2004) Pratical applications of antibiotic loaded bone cement for treatment of infected joint replacements. Clin Orthop Relat Res 427:79–85PubMedCrossRef
15.
Klinger HM, Spahn G, Schultz W, Baums MH (2006) Arthrodesis of the knee after failed infected total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 14:447–453PubMedCrossRef
16.
Talmo CT, Bono JV, Figgie MP, Sculco TP, Laskin RS, Windsor RE (2007) Intramedullary arthrodesis of the knee in treating sepsis after TKR. HSSJ 3:83–88CrossRef
17.
Iacono F, Bruni D, Lo Presti M, Raspugli G, Bondi A, Sharma B, Marcacci M (2012) Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA. Knee 19:555–559PubMedCrossRef
18.
Spina M, Gualdrini G, Fosco M, Giunti A (2010) Knee arthrodesis with the Ilizarov external fixatori as treatment for septic of knee arthroplasty. J Orthop Trauma 11:81–88CrossRef
19.
Garberina MJ, Fitch RD, Hoffmann ED et al (2001) Knee arthrodesis with circular external fixation. Clin Orthop 382:168–178PubMedCrossRef
20.
Manzotti A, Pullen C, Guerreschi F, Catagni MA (2001) The Ilizarov method for failed knee arthrodesis following septic TKR. Knee 8:135–138PubMedCrossRef
21.
Neuerburg C, Bieger R, Jung S, Kappe T, Reichel H, Decking R (2012) Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series. Arch Orthop Trauma Surg 132:1183–1189PubMedCrossRef
22.
Putman S, Kern G, Senneville E, Beltrand E (2013) Migaud H Knee arthrodesis using a customised modular intramedullary nail in failed infected total knee arthroplasty. Orthop Traumatol Surg Res 99(4):391–398PubMedCrossRef
23.
Spangehl MJ, Masri BA, O’Connell JX et al (1999) Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg 81:672–683PubMed
24.
Lequesne M, Mery C, Samson M, Gérard P (1987) Index of severity for osteoarthritis of the hip and knee. Scand J Rheumatol 65:85–89CrossRef
25.
Joulie D, Girard J, Mares O, Beltrand E, Legout L, Dezeque H et al (2011) Factors governing the healing of Staphylococcus aureus infections following hip and knee prosthesis implantation: a retrospective study of 95 patients. Orthop Traumatol Surg Res 97:671–678
26.
McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection. Outcomes using a staging system. Clin Orthop Relat Res 403:8–15PubMedCrossRef
27.
Kuntscher GBG (1948) Recent advances in the Field of Medullary Nailing. Ann Chir Gynaecol Fenniae 37:115–136
28.
Knutson K, Lindstrand A, Lidgren L (1984) Arthrodesis for failed knee arthroplasty: A nationwide multicenter investigation of 91 cases. Clin Orthop 191:202–211PubMed
29.
Puranen J, Kortelainen P, Jalovaara P (1990) Arthrodesis of the knee with intramedullary nail fixation. J Bone Joint Surg Am 72:433–442PubMed
30.
Arroyo JS, Garvin KL, Neff JR (1997) Arthrodesis of the knee with a modular titanium intramedullary nail. J Bone Joint Surg Am 79:26–35PubMedCrossRef
31.
Christie MJ, DeBoer DK, McQueen DA, Cooke FW, Hahn DL (2003) Salvage Procedures for failed Total Knee Arthroplasty. J Bone Joint Surg 85-A(1):58–62
32.
Wilde AH, Stearns KL (1989) Intramedullary fixation for arthrodesis of the knee after infected total knee arthroplasty. Clin Orthop 248:87–92PubMed
33.
Crockarell JR, Mihalko MJ (2005) Knee arthrodesis using an intramedullary nail. J Arthroplasty 20:703–708PubMedCrossRef
34.
Donley BG, Matthews LS, Kaufer H (1991) Arthrodesis of the knee with an intramedullary nail. J Bone Joint Surg Am 73:907–913PubMed
Metadata
Title
Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results
Authors
Sara Scarponi
Lorenzo Drago
Delia Romanò
Nicola Logoluso
Andrea Peccati
Enzo Meani
Carlo L. Romanò
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 2/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2232-7

Other articles of this Issue 2/2014

International Orthopaedics 2/2014 Go to the issue

Original Paper

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Original Paper

Impact of the tibial slope on range of motion after low-contact-stress, mobile-bearing, total knee arthroplasty

Original Paper

Two-stage treatment of infected total knee arthroplasty: two to thirteen year experience using an articulating preformed spacer

Editorial

Knee arthroplasty today

Original Paper

Does computer-assisted total knee arthroplasty improve the overall component position and patient function?

Original Paper

The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis