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Knee Arthrodesis 27580

Unstable revision TKA xray

knee arthrodesis picture

synonyms: knee fusion, knee arthrodesis

Knee Arthrodesis CPT

Knee Arthrodesis Anatomy

  • Final position for knee fusion = 7° ± 5° of valgus and 15° ± 5°of flexion. (Figgie HE III,CORR 1987;224:237)

Knee Arthrodesis Indications

  • Failed TKA
  • Irreparable extensor mechanism
  • Infection
  • Young active patients involved in heavy labor
  • Soft tissue defects
  • Neuropathic joint disease

Knee Arthrodesis Contraindications

  • Bilateral disease
  • Ipsilateral hip arthrodesis
  • Ipsilateral hip arthritis
  • Ipsilateral ankle arthritis

Knee Arthrodesis Alternatives

  • Resection arthroplasty
  • Above-knee amputation (Falahee MH, JBJS 1987;69A:1013)

Knee Arthrodesis Pre-op Planning / Considerations

  • Pre-op medical clearance is needed in most patients.
  • A/P and lateral knee films, standing hip-to-knee alignment xrays. Evaluate pre-op alignment and varify hip and anke are free of significant arthritis. Nail length templated and any bony cuts or hardware removal needed is determined.
  • Pre-operative trial of in cylinder cast or knee immobilizer is valuable to demonstrate post-operative functional abililites to patients.
  • Infection should be eradicated before fusion.

Knee Arthrodesis Techniques

Knee Arthrodesis IM Nail Technique

  • Pre-operative antibiotic.
  • Supine position with bump under hip.
  • Anesthesia: Consider peripheral nerve blocks (Horlocker TT, JAAOS 2006;14:126)
  • Bony prominences well padded
  • Consider foley catheter
  • Mid-line longitudinal incision. Use the most lateral longitudinal parapatellar incision when previous multiple incisions are present. (Vince KG, ICL 1993;42:325)
  • Medial parapatellar arthrotomy
  • Previous TKA components removed.
  • Bone ends cut to ensure bone on bone contact.
  • Tibia is reamed first to deterimine nail size.
  • Femus and tibia shafts prepared and nail placed per IM nail manufactures technique guide.
  • Irrigate.
  • Close in layers.
  • Knee immobilizer or cylinder cast.

Knee Arthrodesis Complications

Knee Arthrodesis Follow-up

  • Post-operative weight-bearing status is depended on type of fixation used and the amount of bone on bone contact achieved. Generally partial weight-bearing until evidence of bony fusion is seen on xray.
  • TKA after arthrodesis has high risk of complication including skin necrosis, infection, and instability.

Knee Arthrodesis Outcomes

  • 83% union, average time to union =5.5 months, average limb-length discrepancy = 5.5 cm. Complications = above-the-knee amputation for recurrence of infection, nail breakage three years after implantation. (Bargiotas K, JBJS 2006;88A:553).

Knee Arthrodesis Review References