Total Knee Arthroplasty Using Patient-specific Blocks after Prior Femoral Fracture without Hardware Removal

BACKGROUND: The options to perform total knee arthroplasty (TKA) with retained hardware in femur are mainly – removal of hardware, use of extramedullary guide, or computer-assisted surgery. Patient-specific blocks (PSBs) have been introduced with many potential advantages, but their use in retained hardware has not been adequately explored. The purpose of the present study was to outline and assess the usefulness of the PSBs in performing TKA in patients with retained femoral hardware. Materials and MATERIALS AND METHODS: Nine patients with retained femoral hardware underwent TKA using PSBs. All the surgeries were performed by the same surgeon using same implants. Nine cases (7 males and 2 females) out of total of 120 primary TKA had retained hardware. The average age of the patients was 60.55 years. The retained hardware were 6 patients with nails, 2 with plates and one patient had screws. Out of the nine cases, only one patient needed removal of a screw which was hindering placement of pin for the PSB. RESULTS: All the patients had significant improvement in their Knee Society Score (KSS) which improved from 47.0 to postoperative KSS of 86.77 (P < 0.00). The mechanical axis was significantly improved (P < 0.03) after surgery. No patient required blood transfusion and the average tourniquet time was 41 min. CONCLUSION: TKA using PSBs is useful and can be used in patients with retained hardware with good functional and radiological outcome.