# Conversion of failed revision total knee arthroplasty in arthrodesis with modular nail maintaining the uncemented femoral stem in patient with extensor mechanism insufficiency: a case report

## TL;DR

A patient with a failed knee replacement was successfully treated with a less invasive surgery to convert the joint into a fused state, preserving the existing femoral implant.

## Contribution

A successful case of converting a failed revision knee replacement to arthrodesis using a modular nail while preserving the femoral stem.

## Key findings

- The conversion resulted in minimal bone and blood loss.
- The patient achieved optimal functional outcomes at one-year follow-up.
- The modular system allowed for a less invasive surgical approach.

## Abstract

The transition from revision total knee arthroplasty (RTKA) to arthrodesis involves the replacement of cemented femoral and tibial stems with a modular nail designed for arthrodesis. This conversion process is associated with challenges such as bone loss, blood loss, and prolonged surgical durations. Effectively addressing these complexities through a less invasive surgical approach could be pivotal in enhancing patient outcomes and minimizing associated complications.

A 75-year-old white Caucasian female patient with a revision total knee arthroplasty (RTKA) performed with a modular uncemented rotating-hinge system, reporting an history of recurrent patellar dislocation, was referred to our institution after a fall resulting in periprosthetic tibial plateau fracture. The fracture was treated with open reduction and internal fixation, but afterwards the patient had been unable to walk again. Tibial stem was mobilized, and extensor mechanism was insufficient due to chronic incomplete quadriceps tendon rupture. The femoral stem was stable, so we decided to convert the rotating-hinge in a arthrodesis with an uncemented modular knee fusion nail maintaining the previous femoral stem.

The result was a successful arthrodesis with minimal bone and blood loss, reduced operative time, and optimal functional outcome at the one-year follow-up. This case highlights the advantage of using a modular knee revision platform system that gives the opportunity to convert a RTKA in arthrodesis.