Salvage of infected intramedullary knee arthrodesis with vascularized free fibula and staged fixation

Injury. 2014 Nov;45(11):1772-5. doi: 10.1016/j.injury.2014.07.003. Epub 2014 Jul 14.


Intramedullary knee arthrodesis is indicated when an infected total knee arthroplasty revision is failed. There is a high risk of infection after this procedure and the only option of treatment considered in these cases is AK amputation. We present an alternative to AK amputation in intramedullary arthrodesis infected cases that has been successful in all patients we have treated. From 2008 to 2012 five patients (4 men and one woman) were treated. The treatment protocol was staged: (1) debridement, removing intramedullary implant and cement, PMMa as spacer and placement of a double-frame external fixator. Gastrocnemius flap was used when there was a significant cutaneous defect. (2) Removing PMMa and transfer a contralateral free fibular osteocutaneous flap. (3) Change external fixation for an internal fixation. There was no mortality associated to the treatment protocol. There were no septic complications after the first and second stages. Two patients developed deep infection after the third stage. One patient developed stress fracture of the fibular flap. All cases showed integration of the fibular bone six to eight months postoperatively. Limb shortening was 3.8cm on average. All patients were able to walk independently with one crutch. In conclusion, although our series is short to export results, our protocol treatment is a good alternative to AK amputation. The treatment entails at least three major surgical procedures through a protracted period of time, but the avoidance of an AK amputation seems worth the risk in a fully informed and compliant patient.

Keywords: Free fibula; Infected knee arthroplasty; Knee arthrodesis; Knee salvage.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Arthrodesis* / methods
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Debridement
  • Device Removal
  • Female
  • Fibula / transplantation*
  • Fracture Fixation, Internal*
  • Humans
  • Limb Salvage* / methods
  • Male
  • Middle Aged
  • Prosthesis-Related Infections / pathology
  • Prosthesis-Related Infections / surgery*
  • Reoperation
  • Surgical Flaps
  • Treatment Outcome


  • Anti-Bacterial Agents