Wilde A H, Stearns K L
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Ohio 44106.
Clin Orthop Relat Res. 1989 Nov(248):87-92.
Knee arthrodesis with curved intramedullary rods was performed in 12 patients after infected total knee arthroplasty. The underlying pathologic condition was osteoarthritis in nine patients and rheumatoid arthritis in three patients. Nine patients with a postoperative follow-up time of greater than two years (average, 34 months; median, 29 months; longest, 55 months) were evaluated for functional results. Six patients obtained a satisfactory knee fusion in an average of 6.6 months (range, three to 11 months; median, five months). Those patients without massive bone loss preoperatively attained a fusion rate of 66.6%. Two thirds of the patients with massive bone loss attained fusion. Indications for surgery in addition to infection included massive bone loss, mixed infection with multiple organisms, infrapatellar tendon rupture, ligamentous instability, and severe valgus deformity with tibial fracture nonunion. Failure occurred in three cases. One was associated with rod breakage; another was due to massive bone resorption; and the third was in a diabetic female with infrapatellar tendon rupture. All patients with successful arthrodesis reported an absence of pain and the ability to ambulate with, at most, a walker. The use of curved intramedullary rods is a convenient technique for obtaining successful arthrodesis after infected total knee arthroplasty.
12例感染性全膝关节置换术后患者接受了使用弯形髓内棒的膝关节融合术。潜在病理状况为9例骨关节炎和3例类风湿关节炎。对9例术后随访时间超过两年（平均34个月；中位数29个月；最长55个月）的患者进行了功能结果评估。6例患者平均在6.6个月（范围3至11个月；中位数5个月）时获得了满意的膝关节融合。术前无大量骨质丢失的患者融合率为66.6%。三分之二有大量骨质丢失的患者实现了融合。除感染外的手术指征包括大量骨质丢失、多种微生物混合感染、髌腱断裂、韧带不稳定以及伴有胫骨骨折不愈合的严重外翻畸形。3例手术失败。1例与棒断裂有关；另1例是由于大量骨质吸收；第3例是一名患有髌腱断裂的糖尿病女性。所有成功进行关节融合术的患者均报告无疼痛，最多使用助行器即可行走。使用弯形髓内棒是感染性全膝关节置换术后获得成功关节融合术的一种简便技术。
