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Arthrodesis of the knee using a custom-made intramedullary coupled device

Department of Trauma and Orthopaedics, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.

W. Mintowt-Czyz, FRCS, Consultant Orthopaedic Surgeon; and V. Barr, MRCS, Senior House Officer

Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, UK.

Correspondence should be sent to Mr S. P. White at 55 Dongola Road, Bristol BS7 9HW, UK.

Nine patients underwent arthrodesis of the knee using a customised coupled nail (the Mayday arthrodesis nail), five after infected arthroplasty, one following failed arthrodesis, one for intractable anterior knee pain, one for Charcot instability and one after trauma. Comparison was made with 17 arthrodeses, eight undertaken using external fixation, four with dual compression plates, and five with long Küntscher nails. Union was achieved in all patients (100%) at a mean time of ten months using the customised implant. There were no complications despite early weight-bearing. No further procedures were required. This contrasted with a rate of union of 53% and a complication rate of 76% with alternative techniques. Of this second group, 76% required a further operative procedure.

We compared the Mayday arthrodesis nail with other techniques of arthrodesis of the knee. The differences in the need for further surgery and occurrence of complications were statistically significant (p < 0.001), and differences in the rate of nonunion and inpatient stay of less than three weeks were also significant (p < 0.05) using Fisher’s exact test.

We conclude that a customised coupled intramedullary nail can give excellent stability allowing early weight-bearing, and results in a high rate of union with minimal postoperative complications.