Arthrodesis of the Knee with a Huckstep Nail Following the Treatment Failure of an Infected Total Knee Arthroplasty

We performed knee arthrodesis with a Huckstep nail in 4 patients that had failed in controlling infection after TKA. The purpose of this study is to introduce our surgical methods and report our clinical results. We retrospectively reviewed 4 patients who underwent knee arthrodesis with a Huckstep nail after the treatment failure of infection following TKA from 2003 to 2007. Mean age was 73 years (70~79 years). All patients had type II diabetes and hypertension. From primary TKA to knee arthrodesis with a Huckstep nail, patients underwent 3.2 operations (3~4 times) on average including removal of implant, synovectomy, antibiotic cement insertion, and revisional TKA. Allo-bone grafting was performed additionally in all cases to minimize lower limb shortening. Patients were evaluated clinically, hematologically and radiologically. The mean duration of follow-up was 20.2 months (12~36 months). All patients showed bony union radiologically within one year. There was no migration or loosening of a nail and screws. Limb length discrepancy was 3 cm on average. Although 1 patient complained ambulatory pain, all patients returned to ambulation without evidence of infection recurrence. Arthrodesis of the knee with a Huckstep nail for patients who had failed in controlling infection after TKA was considered effective treatment option.

Two-Stage Reimplantation in Infected Total Knee Arthroplasty

PURPOSE: We evaluated the usefulness of two-stage revision knee arthroplasty for treatment of infected total knee arthroplasty(TKA). MATERIALS AND METHODS: We retrospectively reviewed 13 cases treated by two-stage reimplantation among the 18 infected TKA cases from February 1993 to March 2003, which had been followed up for more than two years. We analyzed the results of treatment, knee society score before and after the two stage reimplantation, recurrence of infection, and other complications. RESULTS: The mean period between the time of primary TKA and that of diagnosis of deep infection was 1.7 years. The mean period from removal of infected primary prosthesis to the second stage reimplantation was 7.2 weeks. The mean range of motion increased from 60.3 degrees to 95.7 degrees after operation. The mean Knee Society Score increased from 50.2 points to 83.4 points. Infection recurred in two cases but immediately subsided by intravenous antibiotics therapy. One case with patella fracture was treated by total patellectomy. CONCLUSION: This procedure using antibiotics-impregnated cement spacer and complete debridement of necrotic tissues can control infection and improve functional results. The result of two-stage revision for deep infected total knee arthroplasty was satisfactory in view of eradication of infection and functional restoration of the knee.