Published online Jan 18, 2026. doi: 10.5312/wjo.v17.i1.114078
Revised: October 30, 2025
Accepted: December 15, 2025
Published online: January 18, 2026
Processing time: 119 Days and 17.8 Hours
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.
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).
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.