Georgiadis GM, Arefi IA, Drees SM, Nair A, Wagner D, Lawrence AC. Cephalomedullary fusion nails for treatment of infected stemmed revision total knee arthroplasty: Four case reports. World J Orthop 2026; 17(1): 114078 [DOI: 10.5312/wjo.v17.i1.114078]
Corresponding Author of This Article
Gregory M Georgiadis, MD, Department of Orthopaedic Surgery, Promedica Toledo Hospital, 2121 Hughes Dr. Suite 310, Toledo, OH 43606, United States. gregory.georgiadismd@promedica.org
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Orthopedics
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 18, 2026 (publication date) through Jan 9, 2026
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Georgiadis GM, Arefi IA, Drees SM, Nair A, Wagner D, Lawrence AC. Cephalomedullary fusion nails for treatment of infected stemmed revision total knee arthroplasty: Four case reports. World J Orthop 2026; 17(1): 114078 [DOI: 10.5312/wjo.v17.i1.114078]
World J Orthop. Jan 18, 2026; 17(1): 114078 Published online Jan 18, 2026. doi: 10.5312/wjo.v17.i1.114078
Cephalomedullary fusion nails for treatment of infected stemmed revision total knee arthroplasty: Four case reports
Gregory M Georgiadis, Isaac A Arefi, Summer M Drees, Ajay Nair, Drew Wagner, Austin C Lawrence
Gregory M Georgiadis, Department of Orthopaedic Surgery, Promedica Toledo Hospital, Toledo, OH 43606, United States
Isaac A Arefi, Summer M Drees, Ajay Nair, Drew Wagner, Austin C Lawrence, Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH 43606, United States
Author contributions: Georgiadis GM contributed to project originate, supervised the writing of this manuscript, editing and revisions of the final draft; Arefi IA, Drees SM, Nair A, Wagner D, and Lawrence AC assisted with writing the manuscript’s first draft and reviewing the final draft. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gregory M Georgiadis, MD, Department of Orthopaedic Surgery, Promedica Toledo Hospital, 2121 Hughes Dr. Suite 310, Toledo, OH 43606, United States. gregory.georgiadismd@promedica.org
Received: September 12, 2025 Revised: October 30, 2025 Accepted: December 15, 2025 Published online: January 18, 2026 Processing time: 119 Days and 12.3 Hours
Abstract
BACKGROUND
Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems. Reconstructive options are limited. Above knee amputation (AKA) is often recommended. We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion (KF) using a cephalomedullary nail.
CASE SUMMARY
Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF. They were all treated with a statically locked antegrade cephalomedullary fusion nail, augmented with antibiotic impregnated bone cement. All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up. All were infection free at an average follow-up of 25.5 months (range 16-31).
CONCLUSION
Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
Core Tip: Long stem infected revision total knees are challenging and are often treated with above the knee amputation. The authors provide a limb salvage technique for conversion to a knee fusion. A lateral approach to the femur and tibia with extended osteotomies allows for implant removal. A long cephalomedullary nail, supplemented with antibiotic cement, provides for a functional fusion. This a major surgical procedure that will likely involve blood transfusions and intensive care management, and post operative wound problems are common. However, if successful, patients can expect to walk with a shoe lift and a walking aide.
