Intramedullary arthrodesis of the knee after failed total knee arthroplasty.

Eighteen patients (eighteen knees) were managed with an intramedullary arthrodesis after a failed total knee arthroplasty. Twelve knees had had a revision total knee arthroplasty and six, a primary total knee arthroplasty. Three knees had had failure of a hinged prosthesis. In eleven knees, the arthroplasty had failed because of infection. Nine patients had had previous attempts at arthrodesis with external fixation. The average duration of the operation was six hours, and the average blood replacement was 2975 milliliters. A vascularized fibular pedicle graft was used in four patients. At a mean of thirty-seven months after the arthrodesis, sixteen of the eighteen patients had a complete radiographic union. The mean time to union was 5.5 months. Although a high rate of union was achieved in these patients, complications occurred in ten of the eighteen knees and this must be considered. Intramedullary arthrodesis is a successful method of salvage for a failed total knee arthroplasty or one complicated by infection that is not amenable to revision, but it is technically demanding and has frequent complications.