Advanced knee salvage surgery: how custom nail arthrodesis offers new hope after failed replacements

Custom Knee Arthrodesis: A Lifeline After Multiple Failed Replacements
A 2024 case study in GMS Interdisciplinary Plastic and Reconstructive Surgery highlights the success of custom intramedullary knee arthrodesis with a femoral neck screw in preventing fractures during complex revision surgery. This innovative approach restored mobility for a patient with chronic aseptic loosening after 5 failed knee replacements.

Key Findings:
• 75% improvement in Harris Hip Score (24 → 75) and 76% reduction in WOMAC pain scores (86 → 20) at 1-year follow-up.
• No implant loosening or infections observed postoperatively.
• Temporary foot dorsiflexion loss resolved completely within 12 months.
• Precise 3D surgical planning enabled optimal femoral neck screw placement to prevent proximal femur fractures.

Critical Insights for Patients Considering Arthrodesis
This case demonstrates that customized arthrodesis can provide stable, pain-free function even after multiple failed replacements. Key considerations via telehealth include:
• Comparing outcomes of arthrodesis vs. above-knee amputation.
• Evaluating centers with 3D surgical planning capabilities.
• Understanding long-term activity limitations post-fusion.

Why Patients Seek Telehealth Second Opinions for Complex Knee Revisions
1. Access to Revision Specialists: Only 23% of orthopedic surgeons routinely perform knee arthrodesis – telehealth bridges this expertise gap.
2. Implant Customization Questions: Virtual consultations help patients understand if custom nails (vs. standard implants) suit their anatomy.
3. Infection Risk Assessment: 72% of arthrodesis cases follow septic failures – telehealth enables rapid infectious disease specialist input.

The Telehealth Advantage in Post-Arthrodesis Care
• Remote monitoring of weight-bearing progression via gait analysis apps.
• Virtual physical therapy sessions for joint stabilization training.
• Complication triage for early signs of hardware issues or neurological changes.

Source: GMS (German Medical Science journal)

• Mohamed Ghanem – Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Germany; Department of Physical Therapy and Rehabilitation, University Hospital Leipzig, Germany
• Christina Pempe – Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Germany
• Andreas Roth – Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Germany