Bharat Sharma

Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA

INTRODUCTION Knee arthrodesis can be an effective treatment after an infected revision Total Knee Arthroplasty (TKA). The main hypothesis of this study is that a two-stage arthrodesis of the knee using a press-fit, modular intramedullary nail and antibiotic loaded cement, to fill the residual gap between the bone surfaces, prevents an excessive limb shortening, providing satisfactory clinical and functional results even without direct bone-on-bone fusion. MATERIAL AND METHODS The study included 22 patients who underwent knee arthrodesis between 2004 and 2009 because of recurrent infection following revision-TKA (R-TKA). Clinical and functional evaluations were performed using the Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score. A postoperative clinical and radiographical evaluation of the residual limb-length discrepancy was conducted by three independent observers. RESULTS VAS and LAS results showed a significant improvement with respect to the preoperative condition. The mean leg length discrepancy was less than 1cm. There were three recurrent infections that needed further surgical treatment. DISCUSSION This study demonstrated that reinfection after Revision of total knee Arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail, along with an antibiotic loaded cement spacer and that satisfactory results can be obtained without direct bone-on-bone fusion.

61 Navigated Revision Total Knee Replacement

Revision total knee replacement (RTKR) is a skill-demanding intervention presenting several technical challenges to the surgeon. Computer-assisted navigation systems can potentially solve these problems being useful for planning revision surgery. In fact, computer-assisted surgery can help to detect in a more accurate way or in a less invasive manner important anatomical information that often cannot be retrieved with manual instrumentation and that can be very helpful to improve the surgical outcome. Moreover, another crucial aspect is that since planning phase the system allows the surgeon to define an optimal surgical strategy that guarantees joint line restoration and soft tissue balancing. The surgeon can carefully analyze the consequences of each surgical decision including the opportunity to check different implant solutions. Computer-assisted techniques, allowing to compute optimal joint line position, can help to determine the correct augment thickness to be implanted. Moreover, giving a permanent knowledge of the joint line position during the most crucial steps of the procedure, it allows to easily reproduce the planned surgical strategy on the patient.

Revision Total Knee Arthroplasty

Total knee arthroplasty (TKA) is one of the most successful orthopaedic procedures performed today. This is due to the substantial pain relief and restoration of function after TKA. As result of its success [15, 21], indications for TKA have included younger and more active patients. Therefore, the number of revision TKAs is also rising with a projected increase of 601 % from 2005 to 2030 [14]. Although the results of primary TKAs are well documented with implant survivorship at 15 years greater than 95 % [29], the results of revision procedures are less predictable and encouraging with an 82 % survivorship at 12 years. Predominant revision failure modes include infection (46 %), aseptic loosening (19 %) and instability (13 %) [28].