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J Knee Surg 2023; 36(01): 039-046
DOI: 10.1055/s-0041-1729552
Original Article

Treatment of Periprosthetic Joint Infection in Total Knee Arthroplasty with a Temporary Intramedullary Nail: Is a Long or Short Nail Better?

Nequesha S. Mohamed
1   Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Iciar M. Davila Castrodad
2   Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, New Jersey
,
Jennifer I. Etcheson
3   Department of Orthopedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York
,
Margaret N. Kelemen
4   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
F. Johannes Plate
1   Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
,
Janet D. Conway 
4   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Ronald E. Delanois 
4   Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Abstract

To our knowledge, no studies have compared postoperative outcomes between patients who received a temporary short or long intramedullary (IM) nail in the setting of infected total knee arthroplasty (TKA). Therefore, the aim of this study was to compare short-term outcomes for patients who underwent long or short IM nail insertion for treatment of periprosthetic knee infection. Specifically, we compared: (1) success rates; (2) patient reported/functional outcomes; and (3) complications between patients implanted with a short or a long IM nail following PJI of the knee. A retrospective chart review was performed for patients who underwent two-stage exchange arthroplasty with a temporary long or short IM nail between November 2010 and June 2018 at our institution (n = 67). Continuous and categorical variables were assessed using t-test/Mann–Whitney U test and chi-squared test, respectively. Logistic regression analyses were conducted to assess the effect of IM nail length on success rate while adjusting for age, sex, body mass index, and race. A total of 36 patients underwent temporary treatment with a long IM nail, while 31 patients received a short IM nail. There were no differences in success rate for reimplanted patients treated with long and short IM nails (odds ratio 0.992; p = 0.847). Fewer patients with a long IM nail went on to reimplantation (52.8 vs. 83.9%; p = 0.007). There was no difference in satisfaction (7.86 vs. 7.68; p = 0.515), pain scores (3.39 vs. 4.45 points; p = 0.126), or Knee Society score outcome scores (150.61 vs. 166.26 points; p = 0.117) between long or short IM nail patients. Following reimplantation, there was no difference in the number of patients who became reinfected (15.8 vs. 11.5%; p = 0.679) or went on to amputation (0 vs. 7.7%; p = 0.210). Periprosthetic joint infection (PJI) is a rare but serious postoperative complication following TKA. Our findings suggest that the use of long and short IM nails during two-stage exchange can have equal utility in PJI patients with severe bone defects.

Keywords

periprosthetic joint infection - total knee arthroplasty - intramedullary nail - two-stage exchange arthroplasty - revision total knee arthroplasty

Note

Institutional Review Board has determined this project exempt from review as this does not meet the criteria for human subjects research.




Publication History

Received: 27 January 2021

Accepted: 12 March 2021

Article published online:
04 May 2021

© 2021. Thieme. All rights reserved.

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