Updated: 6/11/2021

Knee Arthrodesis

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  • summary
    • Knee arthrodesis is the fusion of the tibiofemoral joint most commonly performed as a salvage for failed TKA or complete loss of extensor mechanism.
    • The optimal position of the knee during fusion is 5° valgus, 0-10° of external rotation, and 0-15° of flexion.
    • Absolute contraindications is presence of active infection.
  • Indications
    • Indications
      • painful ankylosis after infection or trauma
      • neuropathic arthropathy
      • tumor resection
      • salvage for failed TKA (most common)
      • loss of extensor mechanism
  • Contraindications
    • Contraindications
      • absolute
        • active infection
      • relative
        • bilateral knee arthrodesis
        • contralateral leg amputation
        • significant bone loss
        • ipsilateral hip or ankle DJD
  • Technique
    • Optimal Position
      • 5-8° valgus
      • 0-10° of external rotation (match other leg)
      • 0-15° of flexion
      • some limb shortening advantageous for patient self-care
    • Techniques
      • Intramedullary rod fixation
        • technique
          • can be one long antegrade device or a two part device connected at the knee
          • patella can be left alone or incorporated into arthrodesis
      • External fixation
        • technique
          • must allow compression of arthrodesis site
          • done with unilateral external fixation, Ilizarov, or Taylor Spatial Frame
      • Plate fixation
        • technique
          • can be done alone in combination with intramedullary nailing
  • Complications
    • Nonunion
    • Infection
    • Low back pain
    • Ipsilateral hip degenerative changes
    • Contralateral knee degenerative changes
    • Fracture
      • supracondylar femur or proximal tibial metaphysis fractures
        • these occur from increased stress in these regions after arthrodesis

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