[Modular arthrodesis system TITAN (KAM-TITAN) after failed revision total knee arthroplasty : Operative technique and clinical experience].

Abstract

OBJECTIVE\nRestoration of a\xa0painless, weight-bearing extremity with a\xa0modular knee arthrodesis system based on a\xa0cementless modular revision stem for rotationally stable, diaphyseal anchorage.\n\n\nINDICATIONS\nSevere bone loss and compromised soft tissue after failed total knee arthroplasty, two-stage revisions and non-reconstructible knee extensor mechanism deficiency.\n\n\nCONTRAINDICATIONS\nExtensive osteolysis preventing diaphyseal anchorage of the prosthesis. Contralateral arthrodesis of the knee joint and/or ipsilateral arthrodesis of the hip joint and contralateral lower extremity amputation.\n\n\nSURGICAL TECHNIQUE\nIn revision cases, removal of the total knee arthroplasty, spacer, the bone cement and all intramedullary granulation tissue. Reaming the medullary cavity with intramedullary reamers to cortical contact. Restoring leg length and rotation with trial implants. After implantation of the femoral and tibial stems, placing and tensioning of the rotationally aligned coupling elements.\n\n\nPOSTOPERATIVE MANAGEMENT\nMobilization on two forearm crutches from postoperative day 1. Removal of the Redon drains after 48\u202fh. Partial weight bearing of 20\u202fkg for 6\xa0weeks postoperatively. If plain radiographs show unchanged seating of the prosthesis after 6\xa0weeks, loading can be increased by 10\u202fkg per week until full weight bearing is achieved.\n\n\nRESULTS\nBetween 2007 and 2012 clinical data were collected and analyzed retrospectively. A\xa0total of 27\xa0patients had been treated within a\xa0two-stage exchange procedure with implantation of a\xa0modular intramedullary arthodesis nail TITAN (KAM-TITAN). The mean follow-up was 30.9\u202f±\u200912.0\xa0months. A\xa0functional evaluation was performed using the Oxford Knee Score (OKS). The analyzed patients showed a\xa0mean score of 39.2\u202f±\u20098.3. To determine the pain level the Visual Analog Scale (VAS) for pain was used and showed a\xa0mean score of 2.9\u202f±\u20091.3. The rate of definitely free of infection (using Laffer criteria) at last follow-up was 85.2%.