Knee Arthrodesis

Introduction

Indications painful ankylosis after infection or trauma neuropathic arthropathy tumor resection salvage for failed TKA (most common) loss of extensor mechanism Contraindications absolute active infection relative bilateral knee arthrodesis contralateral leg amputation significant bone loss ipsilateral hip or ankle DJD 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

Surgical Technique

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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