Intramedullary Arthrodesis for Periprosthetic Joint Infection After Total Knee Arthroplasty: A Systematic Review of Constructs, Fusion Rates, and Clinical Outcomes.

In 30 seconds

This systematic review and meta-analysis assessed intramedullary arthrodesis for periprosthetic joint infection after total knee arthroplasty, including 55 cohorts and 969 knees. Pooled outcomes included a 6% aseptic failure rate, 4% reoperation rate, and 2% amputation rate; overall complications occurred in 28%, most often recurrent infection (11%). Traditional bone-on-bone fusion constructs had higher failure rates than intercalary prosthetic constructs (12 versus 2%) and cement constructs (12 versus 0%). Failure rates did not differ between cemented and cementless intramedullary components.

Key findings

• Across 55 cohorts comprising 969 knees, pooled aseptic failure was 6%, reoperation 4%, and amputation 2%.
• Overall complications occurred in 28%; recurrent infection was the most frequent complication at 11%.
• Traditional bony fusion failure was 12%, compared with 2% for intercalary prosthetic and 0% for cement constructs.
• Nonambulatory status was reported in 4%; cemented and cementless intramedullary components had no difference in failure rates.

Why it matters

Intramedullary arthrodesis is used as limb salvage after infected knee replacement failure, but the pooled findings show that complications remain common despite relatively low rates of aseptic failure, reoperation, and amputation. The lower reported failure rates with prosthetic and cement constructs suggest that construct type may be relevant when weighing options, while the overall complication burden underscores the importance of discussing risks.

What to keep in mind

The review pooled outcomes from cohorts, and the abstract does not report randomized comparisons between construct types; differences in failure rates therefore should not be interpreted as proof that one construct causes better outcomes.