Results of Knee Arthrodesis Using an Intramedullary Modular Arthrodesis System after Failed Total Knee Arthroplasty after Up to 17 Years.

Purpose: The purpose of this study was to evaluate the clinical, functional, and radiographic outcomes in patients who underwent two-stage cementless arthrodesis following multiple revision surgeries for periprosthetic joint infection (PJI), after a mean follow-up of 57.0 months (range, two to 208).

Methods: From 2002 to 2012, 31 patients underwent a two-stage revision for PJI using an intramedullary modular arthrodesis system. The follow-up evaluation included clinical and functional data, as assessed using the Oxford Knee Score. Furthermore, a gait analysis using three-dimensional motion analysis was performed for five patients. There were 29 patients available for clinical and radiographic follow-up. The mean bone defect was 3.9 centimeters.

Results: There was one reoperation for postoperative hematoma with preservation of the arthrodesis. There were six reinfections after arthrodesis. In three of these cases, preservation of the arthrodesis system was possible after repeated revision surgeries. In two cases, the recurrent infection was treated with another two-stage revision and re-arthrodesis. In one case, the arthrodesis system was removed, and a spacer was implanted. The Kaplan-Meier survival rate was 87.2% (95% confidence interval [CI], 65.3 to 95.7) at 17.3 years for revision for any reason. The risk of reinfection was 19% following two-stage arthrodesis. The limb salvage rate was 100%.

Conclusions: Periprosthetic joint infection can be successfully treated with arthrodesis using a modular intramedullary arthrodesis system without bone-to-bone fusion. Although the risk of reinfection following two-stage revision is 19%, this treatment approach may provide patients with improved quality of life by relieving pain and restoring joint stability.