Modular arthrodesis system TITAN (KAM-TITAN) after failed revision total knee arthroplasty Operative technique and clinical experience

Objective Restoration of a painless, weight-bearing extremity with a modular knee arthrodesis system based on a cementless modular revision stem for rotationally stable, diaphyseal anchorage. Indications Severe bone loss and compromised soft tissue after failed total knee arthroplasty, two-stage revisions and non-reconstructible knee extensor mechanism deficiency. Contraindications Extensive osteolysis preventing diaphyseal anchorage of the prosthesis. Contralateral arthrodesis of the knee joint and/or ipsilateral arthrodesis of the hip joint and contralateral lower extremity amputation. Surgical technique In revision cases, removal of the total knee arthroplasty, spacer, the bone cement and all intramedullary granulation tissue. Reaming the medullary cavity with intramedullary reamers to cortical contact. Restoring leg length and rotation with trial implants. After implantation of the femoral and tibial stems, placing and tensioning of the rotationally aligned coupling elements. Postoperative management Mobilization on two forearm crutches from postoperative day 1. Removal of the Redon drains after 48 & x202f;h. Partial weight bearing of 20 & x202f;kg for 6 weeks postoperatively. If plain radiographs show unchanged seating of the prosthesis after 6 weeks, loading can be increased by 10 & x202f;kg per week until full weight bearing is achieved. Results Between 2007 and 2012 clinical data were collected and analyzed retrospectively. A total of 27 patients had been treated within a two-stage exchange procedure with implantation of a modular intramedullary arthodesis nail TITAN (KAM-TITAN). The mean follow-up was 30.9 & x202f;+/- 12.0 months. A functional evaluation was performed using the Oxford Knee Score (OKS). The analyzed patients showed a mean score of 39.2 & x202f;+/- 8.3. To determine the pain level the Visual Analog Scale (VAS) for pain was used and showed a mean score of 2.9 & x202f;+/- 1.3. The rate of definitely free of infection (using Laffer criteria) at last follow-up was 85.2%.