Cephalomedullary fusion nails for treatment of infected stemmed revision total knee arthroplasty: Four case reports

Table 1 Summary of patient demographics

Case	Age	Sex	BMI (kg/m2)	Comorbidities	Prior knee surgeries (n)	Description of surgeries (year)	Previous post-operative infective organism
1	73	M	63	Morbid obesity; coronary artery disease; type 2 diabetes; atrial fibrillation neuropathy/chronic ipsilateral heel sore; hypertension; chronic venous stasis - right leg; sleep apnea; chronic anemia	4	Initial right TKA (2010); articulating antibiotic cement spacer (2016); long stem revision (2016); debridement with prosthesis retention (2019)	Escherichia coli, Proteus mirabilis
2	78	F	28	Non-Hodgkin’s lymphoma; hypertension; history of deep vein thrombus; history of melanoma; history of basal cell cancer	3	Initial right TKA (2005); long stem revision rotating hinge TKA (2019); arthrotomy (2023)	Coagulase negative staphylococcus
3	59	M	42	Morbid obesity; dyslipidemia; history of alcoholism	5	Initial right TKA (2020); arthrotomy (2021); arthrotomy/poly exchange (2021); articulating knee spacer (2021); long stem revision TKA (2021)	Streptococcus mitis; Enterobacter cloacae; Enterococcus faecalis; Coagulase negative staphylococcus
4	84	M	27	Stage 3 chronic kidney disease; hypothyroidism; chronic pulmonary disease; carotid stenosis; hypertension; Alzheimer’s disease; sleep apnea	7	Initial left TKA (2015); articulating spacer (2016); revision TKA (2017); patellar realignment (2017); second articulating spacer (2017); long stem rotating hinge revision TKA (2018); arthrotomy/poly exchange (2022)	Serratia marcescens

BMI: Body mass index; M: Male; F: Female; TKA: Total knee arthroplasty.

Table 2 Operative summary of patients with infected long stem revision

Case	Operative knee	Pre-op revision implant	Fusion nail diameter (mm)/Length (mm)	Operative time (hours)	Estimated blood loss (mL)	Intra-operative transfusion (mL)
1	Right	Stryker triathlon revision CCK	13/700	6	3600	1800
2	Right	Biomet rotating hinge OSS	11.5/700	8	3500	1800
3	Right	Biomet vanguard revision SSK	11.5/800	10	1500	1200
4	Left	Biomet rotating hinge OSS	11.5/700	10	400	300

Table 3 Summary of patient outcomes

Case	ICU LOS (days)	Wound complication	Total post-op knee surgeries (n)	Description of subsequent surgeries	Follow-up (months)	Ambulatory at last follow-up
1	7	Wound dehiscence	1	Incision and drainage ipsilateral thigh abscess	28	Yes, with rolling platform walker and heel lift
2	8	Wound dehiscence	3	Incision/drainage leg skin graft substitute; skin graft	27	Yes, with walker and shoe lift
3	3	Wound dehiscence	1	Skin graft substitute	31	Yes, with cane and shoe lift
4	1	Wound dehiscence	0	N/A	16 (deceased)	Yes, with Lofstrum crutch and shoe lift

ICU: Intensive care unit; LOS: Length of stay; N/A: Not applicable.