The most common indication for arthrodesis of the knee is an infection at the site of a total knee arthroplasty. Deficiencies in bone stock and poor bone apposition adversely affect the success of a knee arthrodesis. Arthrodesis of the knee can provide a stable, painless extremity for high-functioning patients who are able to walk. Patient function after arthrodesis of the knee is superior to that after above-the-knee amputation. Conversion of a solid knee fusion to a total knee arthroplasty has a substantial complication rate.

Plications of the harvesting technique. Donor site pain and the union rate were compared between the IM and the traditional iliac crest bone graft (ICBG) harvest. Forty-one patients (23 male, 18 female) with an average age of 44.9 years (range, 15-78 years) had graft harvested from long bones using an IM harvest system (femoral donor site, 37 patients; tibial donor site, four patients). Forty patients (23 male, 17 female; average age, 46.4 years; range, 15-77 years) underwent anterior ICBG harvest. We administered patient surveys to both groups to determine pain intensity and frequency. IM group reported lower pain scores than the ICBG group during all postoperative periods. Mean graft volume for the IM harvest group was 40.3 mL (range, 25-75 mL) (graft volume was not obtained for the ICBG group). Using an intramedullary system to harvest autogenous bone graft from the long bones is safe provided a meticulous technique is used. Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence....

Treatment of infected nonunions is a challenge faced by many orthopaedic surgeons. Traditionally, the treatment strategy has been control of the infection followed by procedures to achieve osseous union. Débridement, antibiotic-impregnated cement beads, and intravenous antibiotics have been used for the control of the infection1-3. External or internal fixation methods have been used to achieve stability to promote union. Antibiotic cement-coated intramedullary nails can be used to treat the infection with high doses of local antibiotics and to provide bone stability4. Use of these devices allows immediate weight-bearing and prevents many complications associated with external fixation, such as pin-track infections and joint stiffness. This novel approach to the treatment of infected nonunions was developed to minimize the number of additional surgical procedures required for infection control and to achieve bone union. We present our series of fifty-two patients in whom an antibiotic cement-coated intramedullary nail was inserted for the treatment of an infected nonunion or segmental bone defect. ### Preoperative Planning Careful preoperative planning is essential. It is essential to determine if the patient has a history of allergy to antibiotics so that those antibiotics are not used when mixing the bone cement. The evaluation of intraoperative culture and sensitivity results guides the selection of the appropriate postoperative intravenous antibiotics. Preoperative radiographs, including anteroposterior and lateral views of the involved bone and full-length standing anteroposterior views of both lower extremities made with a 130-cm cassette, should be evaluated. This evaluation allows the surgeon to determine the size of the intramedullary nail that should be used and also provides information regarding the need for additional procedures (such as deformity correction). The length of the intramedullary nail is determined with the same standard method as is used to determine the length of an interlocking nail. For example, when antegrade …

The treatment of infected nonunions is difficult. Antibiotic cement-coated (ACC) rods provide stability as well as delivering antibiotics. We conducted a review of 110 infected nonunions treated with ACC rods. Patients were divided into two groups: group A (67 patients) with an infected arthrodesis, and group B (43 patients) with an infected nonunion in a long bone. In group A, infected arthrodesis, the success rate after the first procedure was 38/67 (57%), 29/67 (43%) required further surgery for either control of infection or non-union. At last follow-up, five patients required amputation, representing a limb salvage rate of 62/67 (93%) overall. In all, 29/67 (43%) presented with a bone defect with a mean size of 6.78 cm (2 to 25). Of those with a bone defect, 13/29 (45%) required further surgery and had a mean size of defect of 7.2 cm (3.5 to 25). The cultures were negative in 17/67 (26%) and the most common organism cultured was methicillin-resistant staphylococcus aureus (MRSA) (23/67, (35%)). In group B, long bones nonunion, the success rate after the first procedure was 26/43 (60%), 17/43 (40%) required further surgery for either control of infection or nonunion. The limb salvage rate at last follow-up was 43/43 (100%). A total of 22/43 (51%) had bone defect with a mean size of 4.7 cm (1.5 to 11.5). Of those patients with a bone defect, 93% required further surgery with a mean size of defect of 5.4 cm (3 to 8.5). The cultures were negative in 10/43 (24%) and the most common organism cultured was MRSA, 15/43 (35%). ACC rods are an effective form of treatment for an infected nonunion, with an acceptable rate of complications.Cite this article: Bone Joint J 2014; 96-B:1349–54