Article

Knee arthrodesis for failed total knee arthroplasty

Archives of Surgery (Impact Factor: 4.3). 04/1985; 120(3):350-4.
Source: PubMed

ABSTRACT The use of arthrodesis to salvage failed total knee arthroplasty is reviewed in nine patients. Prosthetic failure was due to infection in six cases, aseptic loosening in two cases, and instability in one case. The techniques of arthrodesis included six Hoffman external fixators, two fluted intramedullary rods (3M-Orthopedic Products Division, St Paul), and one pulsing electromagnetic field stimulator. Arthrodesis was successful in eight of nine patients, averaging 5.4 months to union. All eight patients resumed a painfree functional level of activity. Meticulous surgical technique and appropriate method of arthrodesis are emphasized.

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    • "Patients undergoing knee arthrodesis are often left with limb shortening particularly following large resections, and prior to skeletal maturity, and there are many advocates for performing simultaneous limb lengthening surgery [29,35-38]. The Ilizarov technique has been successfully utilised with bone transport in a series of 5 proximal tibial GCTs, with a mean defect of 5.7 cm [38], and in 7 distal femoral tumors with defects ranging from 8 to 20 cm [37]; others have also successfully used this technique in non-tumor cases, such as knee arthrodesis following infected total knee arthroplasty [39-42]. "
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    ABSTRACT: This case report describes the management of a 15 year old male with a biologically aggressive chondroblastoma of the knee. Following CT, bone scan, angiography and an open biopsy, the diagnosis was confirmed histologically and immunohistochemically. The patient underwent a 13 cm en-bloc excision of the knee, and knee arthrodesis with simultaneous bone transport using an Ilizarov ring fixator. Following 136 days of bone transport, the patient achieved radiological and clinical bony union after a total frame time of 372 days. He then commenced 50% partial weight-bear in a protective knee brace and gradually worked up to full weight-bearing by 4 months. The patient developed superficial pin tract infections around the k-wires on 2 occasions; these settled with a cephalosporin antibiotic spray and local dressings. At 13 years follow-up there are no signs of disease recurrence or failure at the fusion site. The patient is able to fully weight bear and stand independently on the operated leg. Knee arthrodesis with simultaneous limb-lengthening is an effective treatment modality following en-bloc resection of an aggressive chondroblastoma. The case is discussed with reference to the literature.
    Journal of Orthopaedic Surgery and Research 07/2010; 5(1):1-7. DOI:10.1186/1749-799X-5-47 · 1.58 Impact Factor
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    • "Successful arthrodesis after failed total knee arthroplasty is also difficult to achieve (Knutson et al. 1984, Behr et al. 1985). In our series, 4 out of 5 patients with an arthrodesis continued to experience pain. "
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    ABSTRACT: Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.
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