Between 1997-2002, 8 patients with failed knee prosthesis, underwent "resection arthrodesis" of the knee joint, using a free fibular flap with or without a bone allograft. This was performed at least after two revision attempts to place a spacer or another implant, to maintain limb salvage and avoid amputation. All fibular flaps were taken as osseo-cutaneous flaps for better soft tissue coverage and flap monitoring. Double barreled fibula was used 4 times, Capana method (allograft support) was used once, and in the rest of the patients the fibula was supported by hardware only . In a mean follow-up of 2.3 years (1 – 4.8), all 8 patients are alive with no evidence of disease. All patients achieved solid union within 6-12 weeks. There was no infection complication after surgery. Complications included one revision due to acute bleeding from the anastamotic site wresulting in limb and flap salvage and one partial skin necrosis that was treated surgically.

Salvage of an infected, nearly-failed knee mega prosthesis, using a combination of a free fibular osseo-cutaneous flap with or without a bony allo-graft is a valid and recommended option after several non successful attempts to revise these implants.