Use of an Intramedullary Nail to Guide Distal Femoral Resection in Primary Total Knee Arthroplasty

Case: A 67-year-old female patient presented for total knee arthroplasty (TKA) 4 years after receiving an antegrade femoral nail for bisphosphonate-induced femur fracture. She underwent a single-stage procedure with retention of femoral hardware. The femoral nail was used as a surrogate guide to reference the anatomical axis of the femur to position the distal femoral cutting block with good results. Conclusion: TKA is possible in patients with femoral intramedullary hardware without the need for hardware removal or extramedullary referencing. This report highlights a technique for the alignment of the femoral component by using the implanted femoral nail as an in situ guide for the placement of the distal femoral cutting block.