• Knee Arthrodesis with Internal Fixation

    Definition

    Knee arthrodesis is a procedure that fuses the thigh bone to the lower leg bone at the knee. The joined bones may be secured with plates and screws. This method of support is called internal fixation. It provides support while the bones fuse together.
    Your knee will no longer be able to bend after this surgery.

    Reasons for Procedure

    Knee arthrodesis may only be done if all other repair methods are not appropriate or have failed. It may be done:
    • After a failed knee replacement
    • In patients with chronic joint infections that have led to severe knee damage
    • In patients with debilitating pain that cannot be resolved by other treatment options
    Damage Due to Arthritis
    Knee arthitis
    Copyright © Nucleus Medical Media, Inc.
    Arthrodesis may reduce pain and improve overall function. However, it will prevent bending at the knee and will cause a limp.

    Possible Complications

    Your doctor will review a list of possible complications, which may include:
    • Excess bleeding
    • Adverse reaction to anesthesia such as light-headedness, low blood pressure, wheezing
    • Infection
    • Blood clots
    • Loosening of components is possible in patients with poor bone quality
    • Aggravation of current medical conditions
    • The thigh and shin bones do not join together as expected
    Factors that may increase the risk of problems include:
    • Smoking
    • Some chronic diseases, like obesity or diabetes
    • Heavy alcohol use
    Make sure you talk to your doctor about these risks before your procedure.

    What to Expect

    Prior to Procedure

    Your doctor may do the following before your procedure:
    • Physical exam
    • Blood tests
    • Imaging tests, like x-rays or scans
    • Electrocardiogram for heart function
    • Have you donate blood in case you need a transfusion
    • Prescribe antibiotics to prevent infection
    Before surgery, you will need to:
    • Arrange for a ride home.
    • Arrange for help at home while you recover.
    • Talk to your doctor about any medications, herbs, or supplements you are taking.
    • Talk to your doctor about any allergies you have.
    • Ask your doctor about devices you will need after the surgery like a wheelchair, walker, or cane.
    You may need to stop taking some medications up to one week before the procedure. Medications that may need to be stopped may include:
    • Aspirin and other nonsteroidal anti-inflammatories
    • Blood-thinning drugs, such as warfarin
    • Anti-platelet drugs, such as clopidogrel
    Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

    Anesthesia

    General anesthesia will be used. You will be asleep during the surgery.

    Description of the Procedure

    An incision will be made over the knee. The ends of the thigh bone and top of the lower leg bone will be removed. This will remove all of the knee joint structures. The ends of the bones will be joined together. Metal plates will be screwed into the joined bones.
    The incision will be closed. A bandage may be placed over the incision.

    How Long Will It Take?

    About two hours

    Will It Hurt?

    Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

    Average Hospital Stay

    The usual length of stay is about three to four days. It is possible that you may have to stay longer if complications arise. You may also go to a rehabilitation hospital to help you recover.

    Post-procedure Care

    At the Hospital
    Right after the procedure, you may be given medication such as:
    • Pain medication
    • Antibiotics to prevent infection
    • Medication that prevents blood clots
    Physical therapy often starts within 24 hours after your surgery. During this time you may need devices to help you walk.
    You will be able to leave when you are able to get around and do basic daily care activities on your own.
    At Home
    When you return home, take these steps:
    • Follow your doctor’s instructions on cleaning the incision site.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Follow your doctor’s instructions on sitting, bending, or sleeping positions.
    Follow your doctor or physical therapist’s exercise program.
    Be sure to follow all of your doctor’s instructions.

    Call Your Doctor

    Call your doctor if any of these occur:
    • Signs of infection such as fever or chills
    • Problems at the incision site such as redness, swelling, pain, bleeding, or draining
    • Nausea or vomiting
    • Pain that does not go away with the pain medicine
    • Numbness or tingling in lower leg
    • Chest pain or trouble breathing
    If you have an emergency, call for medical help right away.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://aaos.org

    Arthritis Foundation http://www.arthritis.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    The Arthritis Society http://www.arthritis.ca

    References

    Bono James, Talmo Carl, et al. Arthrodesis of the Knee: Indications and Treatment Options. Techniques in Knee Surgery . 2009;8(4):212-215.

    Fusion (Arthrodesis). Knee 1 website. Available at: http://www.knee1.com/Education%5FCenter/Therapies/Fusion%5FArthrodesis. Updated October 26, 2001. Accessed January 16, 2013.

    Hospital Admission and Your Medications Before Surgery. http://www.keggiorthosurgery.com/Hospital%5FAdmission%5FAnd%5FYour%5FMedications.php . Accessed January 16, 2013.

    Joint Revision Surgery-When Do I Need It? American Academy of Orthopaedic Surgeons OrthoInfo website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00510 . Updated September 2007. Accessed January 16, 2013.

    Knee Arthrodesis. Bone and Spine website. Available at: http://boneandspine.com/non-traumatic-disorders/joints/knee-arthrodesis/ . Updated November 14, 2011. Accessed January 16, 2013.

    Knee Fusion. Knee Guru website. Available at: http://www.kneeguru.co.uk/KNEEnotes/node/1844 . Accessed January 23, 2013.

    Knee Fusion for Irretrievably Failed Total Knee Replacement. About Joints website. Available at: http://aboutjoints.com/physicianinfo/topics/fusionknee/kneefusion.htm . Accessed January 16, 2013.

    Revision Hip and Knee Surgery. Orthopaedics New England website. Available at: http://www.keggiorthosurgery.com/Revision%5FHip%5FAnd%5FKnee%5FSurgery.php . Accessed January 16, 2013.

    Surgical Wound Infection. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated November 30, 2012. Accessed January 16, 2013.

    Talmo CT, Bono JV, et al. Intramedullary Arthrodesis of the Knee in the Treatment of Sepsis after TKR. HSS J . 2007;3(1):83-88.

    Revision Information

    • Reviewer:
    • Review Date: 06/2013
    • Update Date: 06/24/2013
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