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Kuntscher nail

Knee replacement after previous Kuntscher nail

After sustaining significant tibial and femoral fracture whilst on military service 50 years ago, this gentleman received what was at the time cutting edge orthopaedic fixation and had a Kuntscher nail inserted inside his femur to splint and fix the fracture.

Removing metalwork that has been on or in a bone for some time can be very challenging. An unsucessful attempt was made at least 20 years ago to remove this Kuntscher nail.

This patient subsequently went on to develop severe stiffness and arthritis in the ipsilateral knee.

In 2015, the pain from Mr Eden’s knee arthritis affected his quality of life so profoundly that he was referred for an opinion regarding a knee replacement.

Conventional knee replacement technique usually involves placing a rod temporarily inside the femur to align the knee replacement correctly when it is fitted. This was not possible in Mr Eden’s case due to the Kuntscher nail.

Patient specific instrumentation (PSI) can be very helpful in the context of previous fractures around the knee and requires an MRI scan of the hip, knee and ankle to map the alignment of the limb. This technique cannot be used however if the internal metalwork (in this case the Kuntscher nail as illustrated) extends to within 15cms of the knee joint.

A novel new technology allowing wireless computer aided navigation was used to perform this step of the procedure therefore.