Cephalomedullary fusion nails for treatment of infected stemmed revision total knee arthroplasty: Four case reports

BACKGROUND: Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems. Reconstructive options are limited. Above knee amputation (AKA) is often recommended. We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion (KF) using a cephalomedullary nail. CASE SUMMARY: Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF. They were all treated with a statically locked antegrade cephalomedullary fusion nail, augmented with antibiotic impregnated bone cement. All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up. All were infection free at an average follow-up of 25.5 months (range 16-31). CONCLUSION: Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.