Andriy Kalashnikov (Kyiv / UA), Yevhenii Chip (Poltava / UA), Oleskandr Pelypenko (Poltava / UA)
Abstract text (incl. references and figure legends)
Relevance. Knee arthrodesis, namely the elimination of a joint, has a restricted field of application, especially with the collateral joint immobilized. However, in some cases: in patients with periprosthetic fractures and prosthetic components' instability, excessive body weight and severe comorbid conditions, knee arthrodesis may become the remedy to preserve the limb's weight-bearing capacity and create conditions for early rehabilitation. It might appear final intervention to ensure a result acceptable for patients.
Clinical case. A female patient, 68 years old. Diagnosis at hospitalization: periprosthetic fracture of a lower third of the left femur. Aseptic instability of the femoral component of her knee endoprosthesis, defects of left femoral condyles. Conditions after the right knee joint arthrodesis. 3rd stage of obesity (body weight - 160 kg, height - 160 cm). Severe comorbid pathology (Charlson index 4), including a neurogenic dysfunction of a bladder.
During the pre-operation planning, we considered different variants to fix the fracture. Plates and IM nailing looked unattractive due to the instability of the endoprosthesis and femoral condylar defects. Severe comorbid pathology and obesity limited options for revision arthroplasty. As an option, we considered an amputation on the level of the middle third of the femur. However, the patient abandoned it categorically.
Finally, we have chosen a special modular IM nail for arthrodesis FN (by a Polish manufacturer) for surgical treatment. This implant ensured osteosynthesis of the femoral bone and recovery of the length of the extremity thanks to the metal cages we applied, having removed impaired condyles during the surgery.
Conclusions. The modular IM nail for knee arthrodesis ensured early verticalization of the patient, the recovery of the length of the extremity and consolidation of the femoral fracture. The patient was satisfied with the result despite the restrictions in daily routines.
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