Knee stabilisation following infected knee arthroplasty with bone loss and extensor mechanism impairment using a modular cemented nail

Abstract 

Infected Total Knee Replacement with significant bone loss and loss of extensor mechanism poses a difficult management problem. Arthrodesis relying on bony union can be difficult to achieve and can result in significant limb shortening. We retrospectively looked at the outcome of seven patients with significant bone loss and extensor mechanism insufficiency following infected TKR who underwent knee stabilisation using a modular cemented nail. The nail relied on the strong coupling mechanism between the modular femoral and tibial components. Pain score improved from a mean of 7.9 pre-operatively to 1.5 post-operatively at a mean follow up of 39.6 months (range 7–68) months. Two patients underwent technically easy revision nailing for recurrent infection and aseptic loosening. The Endo-Model® Knee Fusion Nail (Newsplint, UK/Waldemar Link®, GmbH & Co. KG, Hamburg, Germany) has good early results in terms of pain relief and provides a stable knee in cases with significant bone loss and extensor mechanism insufficiency following an infected TKR thus avoiding an above knee amputation.

Keywords: Revision, Knee, Arthrodesis, Infected, Arthroplasty