Cement Arthrodesis with a Long Cephalomedullary Nail after Failed Total Knee Arthroplasty (TKA) Improves Ambulation and Prevents Recurrent Infection

Introduction: We have designed a novel treatment algorithm utilizing a customized cephalomedullary nail combined with an antibiotic eluting cement spacer to treat persistent periprosthetic joint infection (PJI) and improve ambulation in patients with failed TKA.

Methods: Thirteen consecutive patients were retrospectively identified who underwent cement arthrodesis after failed TKA secondary to infection from 2004-2016. Patients who were deceased, unreachable, or had

Results: Average age at surgery was 68 (range 50-81) years with average follow up of 3.5 (range 2-6) years. 69% (9/13) of patients were unable to ambulate before arthrodesis and had an average of 9 (range 2-30) prior knee procedures. 92% (12/13) of patients were able to ambulate after arthrodesis at last follow up. The complication rate was 15% (2/13). One patient required debridement of a superficial wound infection that subsequently healed uneventfully. One patient ultimately underwent amputation for persistent MRSA infection. Average SF-12 Physical and Mental scores were 32±7 and 43±9 respectively at last follow-up. Eradication of index infection was 92% (12/13). Five of the 6 patients excluded from the analysis returned to ambulation from preoperative immobility with uncomplicated eradication of their index infection.

Discussion: Cement arthrodesis utilizing a custom knee spanning cephalomedullary nail combined with an antibiotic eluting spacer improved ambulatory status and successfully treated recurrent infection in the majority of patients who had failed TKA.