Can A Silver Coated Arthrodesis Implant Provide A Viable Alternative To Above Knee Amputation In The Unsalvageable Infected Total Knee Arthroplasty?

Abstract Background In the unsalvageable, infected total knee arthroplasty (TKA), knee arthrodesis is one treatment option with lower reported reinfection rates compared to repeated two-stage revision and improved function compared to amputation. One possible method for reducing incidence of recurrent infection treated by arthrodesis is the use of a silver coated implant. We report our experience of silver-coated arthrodesis nails used for managing infected revision arthroplasty. We primarily assess the rate of reinfection, rate of amputation and report functional outcome measures. Methods Retrospective analysis of all patients undergoing knee arthrodesis with a silver-coated arthrodesis nail between 2008 and 2014. Patient reported data was recorded pre and post-arthrodesis (OKS and short-form-36 (SF-36)) as well as evidence of recurrent of infection, subsequent surgery and the necessity for amputation. Results Eight patients underwent arthrodesis using the silver-coated arthrodesis nail. Mean duration of follow up was 16 months (5-35 months). At the point of follow up there were no amputations, deaths or implant revisions. One case of recurrent infection was successfully treated with washout and debridement. The mean pre and post-arthrodesis OKS difference was +8.9 points (p=0.086) with significantly improved pain (p=0.019), night pain (p=0.021) and ease of standing (p=0.003). Conclusions Arthrodesis of the knee using a silver-coated intramedullary device is successful in eradicating infection and allowing limb conservation. Where infection does recur, this can be successfully treated with implant retention. The use of a silver coated arthrodesis nail should be considered as an alternative to amputation for patients with a multiply revised, infected TKA.