Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2015; 6(2): 202-210
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.202
Advanced concepts in knee arthrodesis
Jennifer H Wood, Janet D Conway
Jennifer H Wood, Department of Orthopaedics, University of Maryland School of Medicine, University of Maryland Medical System, Baltimore, MD 21201, United States
Janet D Conway, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, United States
Author contributions: Wood JH and Conway JD contributed equally to this work by analyzing the available literature and developing concepts to be presented; Wood JH wrote and revised the manuscript; Conway JD provided a framework for this review, provided critical content and expert opinion, revised the manuscript, and contributed collective patient experience.
Conflict-of-interest: Janet D Conway has received fees from Biomet and Depuy Synthes for serving as a consultant, has received royalties from the University of Florida, and has received research funding from Medtronic Sofamor Danek, Kinetic Concepts, Inc., and CD Diagnostics; Jennifer H Wood does not have any conflicts of interest to report.
Open-Access: 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/
Correspondence to: Janet D Conway, MD, Head of Bone and Joint Infection, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Ave, Baltimore, MD 21215, United States. jconway@lifebridgehealth.org
Telephone: +1-410-6019000 Fax: +1-410-6014292
Received: September 6, 2014
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
Processing time: 194 Days and 13.5 Hours
Abstract

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.

Keywords: Arthroplasty; Knee; Arthrodesis; Nonunion; Limb salvage; Limb length inequality; Infection; Osteomyelitis; Bone lengthening; External fixator

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.