Archives of Orthopaedic and Trauma Surgery - 2026-08-07 - Journal Article; Comparative Study
A comparative analysis of three knee arthrodesis techniques to manage failed total knee arthroplasty due to infection: intramedullary nailing, LRS external fixator, and compression plating.
Rajasekaran RB, Ponniah HS, Palanisami DR, Sundaram VP, Palanivelayutham SS, Jayaramaraju D, Dhanasekaran S, Rajasekaran S
Topics
Key Takeaway
External fixation achieved 100% infection eradication and the shortest time to union with zero amputations among three knee arthrodesis techniques for failed infected TKA, versus four amputations in the IMN and CP groups combined.
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Summary
This study compared EF, IMN, and CP for knee arthrodesis following failed infected TKA across 46 patients treated by four surgeons from 2008–2023. Overall fusion rate was 89.1% (41/46), with EF demonstrating 100% infection eradication, significantly shorter time to union versus IMN (p=0.02), and no amputations, while CP also achieved shorter union time than IMN (p<0.001). Overall patient satisfaction was 82.6%, with most reporting no pain at final follow-up.
Key Limitation
Surgeon-determined technique allocation without randomization means the three groups are not comparable at baseline, and sicker or more complex infection cases may have been systematically directed to EF, inflating its apparent superiority.
Original Abstract
INTRODUCTION
This study compared external fixation (EF), intramedullary nailing (IMN), and compression plating (CP) for knee arthrodesis (KA) following failed total knee arthroplasty (TKA) due to periprosthetic joint infection, focusing on complications, radiological, and functional outcomes.
METHODS
Patients aged ≥ 18 who underwent knee arthrodesis following failed TKA due to infection from 2008 to 2023 were included. Four surgeons used three techniques: EF, IMN, and CP. Retrospective data on demographics, surgical techniques, complications, and outcomes were collected. Postoperative patient-reported outcome measures (PROMs), pain, and functional status were assessed. Radiographic data was reviewed for limb shortening and union status.
RESULTS
46 patients (mean age 61.9 years, BMI 28.2), predominantly male (84.8%) were involved in this study. Twenty patients underwent EF, 16 underwent CP, and 10 underwent IMN, all for infected primary TKA. Pseudomonas was the most common infecting organism (15.2%). Average follow-up was 29.1 months. Bony fusion was achieved in 41 knees (89.1%), with five requiring additional surgery; four eventually required amputation due to non-fusion. EF group had the shortest time to union and no major complications or amputations. Time to union was significantly shorter in the CP group compared to the IMN group (p < 0.001), and EF group also had a significantly shorter time to union compared to IMN (p = 0.02). Infection eradication was 100% in the EF group, with significantly fewer additional surgeries and complications compared to the IMN group. Overall patient satisfaction was high (82.6%), with most patients reporting no pain and functional outcomes ranging from mild limitation to fully normal function.
CONCLUSION
KA has shown to be an effective method to control infection, achieve fusion and provide pain relief following failed infected TKA. EF emerged as the preferable method for knee arthrodesis, showing fewer complications, shorter union times, and no additional surgeries compared to IMN and CP.