Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.202
Peer-review started: September 6, 2014
First decision: October 14, 2014
Revised: November 7, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: March 18, 2015
The aim is to describe advanced strategies that can be used to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.
Core tip: Knee arthrodesis nonunion can be treated effectively with autologous bone grafting and two modes of fixation such as a plate and intramedullary rod. The hardware in a well-fused but infected knee arthrodesis is surgically challenging to remove, but preserving the intact knee fusion is critical. Symptomatic limb length discrepancy after knee arthrodesis can be treated with intramedullary lengthening devices or lengthening over a rod. Temporary knee arthrodesis provides a stable, durable solution to treat infection after total knee arthroplasty in an obese patient.