Skip to main content
SpringerLink
Log in

Knee Arthrodesis

  • Chapter
  • First Online:
Book cover Periprosthetic Joint Infection of the Hip and Knee

  • 1678 Accesses

Abstract

Knee arthrodesis is a salvage procedure suited for a painful knee which is not amenable to other forms of treatment such as primary or revision total knee arthroplasty. The leading current indication is treatment of a periprosthetic joint infection. Several methods for knee arthrodesis have been described including intramedullary fusion nails, external fixators, and dual plating techniques. Modern intramedullary nails allow fusion through a single incision and have the highest reported rates of fusion. Knee arthrodesis for infection should be performed in a staged fashion with an antibiotic spacer similar to staged treatment for an infected total knee arthroplasty. Both the patient and surgeon should be aware of the functional implications of knee arthrodesis including difficulty with stairs, inclines, sitting, and the use of public transportation. Following successful fusion patients should anticipate reliable pain relief but may require an assistive device for ambulation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

DBM:

Demineralized bone matrix

PJI:

Periprosthetic joint infection

References

  1. Hibbs R. The treatment of tuberculosis of the joints of the lower extremities by operative fusion. J Bone Joint Surg. 1930;12:749–60.

    Google Scholar 

  2. Charnley JC. Positive pressure in arthrodesis of the knee joint. J Bone Joint Surg Br. 1948;30B(3):478–86. Epub 1948/08/01.

    PubMed  CAS  Google Scholar 

  3. Charnley J, Baker SL. Compression arthrodesis of the knee; a clinical and histological study. J Bone Joint Surg Br. 1952;34-B(2):187–99. Epub 1952/05/01.

    PubMed  CAS  Google Scholar 

  4. Charnley J, Lowe HG. A study of the end-results of compression arthrodesis of the knee. J Bone Joint Surg Br. 1958;40-B(4):633–5. Epub 1958/11/01.

    PubMed  CAS  Google Scholar 

  5. Brodersen MP, Fitzgerald Jr RH, Peterson LF, Coventry MB, Bryan RS. Arthrodesis of the knee following failed total knee arthroplasty. J Bone Joint Surg Am. 1979;61(2):181–5. Epub 1979/03/01.

    PubMed  CAS  Google Scholar 

  6. Ellingsen DE, Rand JA. Intramedullary arthrodesis of the knee after failed total knee arthroplasty. J Bone Joint Surg Am. 1994;76(6):870–7. Epub 1994/06/01.

    PubMed  CAS  Google Scholar 

  7. Hak DJ, Lieberman JR, Finerman GA. Single plane and biplane external fixators for knee arthrodesis. Clin Orthop Relat Res. 1995;316:134–44. Epub 1995/07/01.

    PubMed  Google Scholar 

  8. Hanssen AD, Trousdale RT, Osmon DR. Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty. Clin Orthop Relat Res. 1995;321:55–67. Epub 1995/12/01.

    PubMed  Google Scholar 

  9. Knutson K, Hovelius L, Lindstrand A, Lidgren L. Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases. Clin Orthop Relat Res. 1984;191:202–11. Epub 1984/12/01.

    PubMed  Google Scholar 

  10. Knutson K, Lindstrand A, Lidgren L. Arthrodesis for failed knee arthroplasty. A report of 20 cases. J Bone Joint Surg Br. 1985;67(1):47–52. Epub 1985/01/01.

    PubMed  CAS  Google Scholar 

  11. MacDonald JH, Agarwal S, Lorei MP, Johanson NA, Freiberg AA. Knee arthrodesis. J Am Acad Orthop Surg. 2006;14(3):154–63. Epub 2006/03/08.

    PubMed  Google Scholar 

  12. Pickering R. Arthodesis of the ankle, knee and hip. In: Canale ST, Beaty JH editors. Campbell's Operative Orthopaedics. St Louis: Mosby; 2007. p. 163–193.

    Google Scholar 

  13. Rand JA, Bryan RS. The outcome of failed knee arthrodesis following total knee arthroplasty. Clin Orthop Relat Res. 1986;205:86–92. Epub 1986/04/01.

    PubMed  Google Scholar 

  14. Rand JA, Bryan RS, Chao EY. Failed total knee arthroplasty treated by arthrodesis of the knee using the Ace-Fischer apparatus. J Bone Joint Surg Am. 1987;69(1):39–45. Epub 1987/01/01.

    PubMed  CAS  Google Scholar 

  15. Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999;81(10):1434–45. Epub 1999/10/27.

    PubMed  CAS  Google Scholar 

  16. Woods GW, Lionberger DR, Tullos HS. Failed total knee arthroplasty. Revision and arthrodesis for infection and noninfectious complications. Clin Orthop Relat Res. 1983;173:184–90. Epub 1983/03/01.

    PubMed  Google Scholar 

  17. Bargiotas K, Wohlrab D, Sewecke JJ, Lavinge G, Demeo PJ, Sotereanos NG. Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. J Bone Joint Surg Am. 2006;88(3):553–8. Epub 2006/03/03.

    Article  PubMed  Google Scholar 

  18. Bargiotas K, Wohlrab D, Sewecke JJ, Lavinge G, DeMeo PJ, Sotereanos NG. Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt.1):103–10. Epub 2007/03/03.

    PubMed  Google Scholar 

  19. Conway JD, Mont MA, Bezwada HP. Arthrodesis of the knee. J Bone Joint Surg Am. 2004;86-A(4):835–48. Epub 2004/04/08.

    PubMed  Google Scholar 

  20. Yeoh D, Goddard R, Macnamara P, Bowman N, Miles K, East D, et al. A comparison of two techniques for knee arthrodesis: the custom made intramedullary Mayday nail versus a monoaxial external fixator. Knee. 2008;15(4):263–7. Epub 2008/04/26.

    Article  PubMed  Google Scholar 

  21. Salem KH, Keppler P, Kinzl L, Schmelz A. Hybrid external fixation for arthrodesis in knee sepsis. Clin Orthop Relat Res. 2006;451:113–20. Epub 2006/05/25.

    Article  PubMed  Google Scholar 

  22. McQueen DA, Cooke FW, Hahn DL. Knee arthrodesis with the Wichita Fusion Nail: an outcome comparison. Clin Orthop Relat Res. 2006;446:132–9. Epub 2006/05/05.

    Article  PubMed  CAS  Google Scholar 

  23. Pritchett JW, Mallin BA, Matthews AC. Knee arthrodesis with a tension-band plate. J Bone Joint Surg Am. 1988;70(2):285–8. Epub 1988/02/01.

    PubMed  CAS  Google Scholar 

  24. Knutson K, Bodelind B, Lidgren L. Stability of external fixators used for knee arthrodesis after failed knee arthroplasty. Clin Orthop Relat Res. 1984;186:90–5. Epub 1984/06/01.

    PubMed  Google Scholar 

  25. Stewart MJ, Bland WG. Compression in arthrodesis; a comparative study of methods of fusion of the knee in ninety-three cases. J Bone Joint Surg Am. 1958;40-A(3):585–606. Epub 1958/06/01.

    PubMed  CAS  Google Scholar 

  26. Bosworth DM. Knee fusion by the use of a three-flanged nail. J Bone Joint Surg Am. 1946;28:550–4. Epub 1946/07/01.

    PubMed  CAS  Google Scholar 

  27. Bose WJ, Gearen PF, Randall JC, Petty W. Long-term outcome of 42 knees with chronic infection after total knee arthroplasty. Clin Orthop Relat Res. 1995;319:285–96. Epub 1995/10/01.

    PubMed  Google Scholar 

  28. Brashear HR. The value of the intramedullary nail for knee fusion particularly for the Charcot joint. Am J Surg. 1954;87(1):63–5. Epub 1954/01/01.

    Article  PubMed  CAS  Google Scholar 

  29. Crockarell Jr JR, Mihalko MJ. Knee arthrodesis using an intramedullary nail. J Arthroplasty. 2005;20(6):703–8. Epub 2005/09/06.

    Article  PubMed  Google Scholar 

  30. Donley BG, Matthews LS, Kaufer H. Arthrodesis of the knee with an intramedullary nail. J Bone Joint Surg Am. 1991;73(6):907–13. Epub 1991/07/01.

    PubMed  CAS  Google Scholar 

  31. Fern ED, Stewart HD, Newton G. Curved Kuntscher nail arthrodesis after failure of knee replacement. J Bone Joint Surg Br. 1989;71(4):588–90.

    PubMed  CAS  Google Scholar 

  32. Goldberg JA, Drummond RP, Bruce WJ, Viglione W, Lennon WP. Huckstep nail arthrodesis of the knee: a salvage for infected total knee replacement. Aust N Z J Surg. 1989;59(2):147–50. Epub 1989/02/01.

    Article  PubMed  CAS  Google Scholar 

  33. Harris CM, Froehlich J. Knee fusion with intramedullary rods for failed total knee arthroplasty. Clin Orthop Relat Res. 1985;197:209–16. Epub 1985/07/01.

    PubMed  Google Scholar 

  34. Incavo SJ, Lilly JW, Bartlett CS, Churchill DL. Arthrodesis of the knee: experience with intramedullary nailing. J Arthroplasty. 2000;15(7):871–6. Epub 2000/11/04.

    Article  PubMed  CAS  Google Scholar 

  35. Lai KA, Shen WJ, Yang CY. Arthrodesis with a short Huckstep nail as a salvage procedure for failed total knee arthroplasty. J Bone Joint Surg Am. 1998;80(3):380–8. Epub 1998/04/08.

    PubMed  CAS  Google Scholar 

  36. Puranen J, Kortelainen P, Jalovaara P. Arthrodesis of the knee with intramedullary nail fixation. J Bone Joint Surg Am. 1990;72(3):433–42. Epub 1990/03/01.

    PubMed  CAS  Google Scholar 

  37. Talmo CT, Bono JV, Figgie MP, Sculco TP, Laskin RS, Windsor RE. Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR. HSS J. 2007;3(1):83–8. Epub 2008/08/30.

    Article  PubMed  Google Scholar 

  38. Wilde AH, Stearns KL. Intramedullary fixation for arthrodesis of the knee after infected total knee arthroplasty. Clin Orthop Relat Res. 1989;248:87–92. Epub 1989/11/01.

    PubMed  Google Scholar 

  39. Arroyo JS, Garvin KL, Neff JR. Arthrodesis of the knee with a modular titanium intramedullary nail. J Bone Joint Surg Am. 1997;79(1):26–35. Epub 1997/01/01.

    Article  PubMed  CAS  Google Scholar 

  40. Barton TM, White SP, Mintowt-Czyz W, Porteous AJ, Newman JH. A comparison of patient based outcome following knee arthrodesis for failed total knee arthroplasty and revision knee arthroplasty. Knee. 2008;15(2):98–100. Epub 2008/01/08.

    Article  PubMed  CAS  Google Scholar 

  41. Christie MJ, DeBoer DK, McQueen DA, Cooke FW, Hahn DL. Salvage procedures for failed total knee arthroplasty. J Bone Joint Surg Am. 2003;85-A Suppl 1:S58–62. Epub 2003/01/24.

    PubMed  Google Scholar 

  42. McQueen DA, Cooke FW, Hahn DL. Intramedullary compression arthrodesis of the knee: early experience with a new device and technique. J Arthroplasty. 2005;20(1):72–8. Epub 2005/01/22.

    Article  PubMed  Google Scholar 

  43. Waldman BJ, Mont MA, Payman KR, Freiberg AA, Windsor RE, Sculco TP, et al. Infected total knee arthroplasty treated with arthrodesis using a modular nail. Clin Orthop Relat Res. 1999;367:230–7. Epub 1999/11/05.

    Article  PubMed  Google Scholar 

  44. White SP, Porteous AJ, Newman JH, Mintowt-Czyz W, Barr V. Arthrodesis of the knee using a custom-made intramedullary coupled device. J Bone Joint Surg Br. 2003;85(1):57–61. Epub 2003/02/15.

    Article  PubMed  CAS  Google Scholar 

  45. Hagemann WF, Woods GW, Tullos HS. Arthrodesis in failed total knee replacement. J Bone Joint Surg Am. 1978;60(6):790–4. Epub 1978/09/01.

    PubMed  CAS  Google Scholar 

  46. Green DP, Parkes II JC, Stinchfield FE. Arthrodesis of the knee. A follow-up study. J Bone Joint Surg Am. 1967;49(6):1065–78. Epub 1967/09/01.

    PubMed  CAS  Google Scholar 

  47. Kutscha-Lissberg F, Hebler U, Esenwein SA, Muhr G, Wick M. Fusion of the septic knee with external hybrid fixator. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):968–74. Epub 2006/03/23.

    Article  PubMed  CAS  Google Scholar 

  48. Nichols SJ, Landon GC, Tullos HS. Arthrodesis with dual plates after failed total knee arthroplasty. J Bone Joint Surg Am. 1991;73(7):1020–4. Epub 1991/08/01.

    PubMed  CAS  Google Scholar 

  49. Wiedel JD. Salvage of infected total knee fusion: the last option. Clin Orthop Relat Res. 2002;404:139–42. Epub 2002/11/20.

    Article  PubMed  Google Scholar 

  50. Bengston S, Knutson K, Lidgren L. Treatment of infected knee arthroplasty. Clin Orthop Relat Res. 1989;245:173–8. Epub 1989/08/01.

    PubMed  Google Scholar 

  51. Falahee MH, Matthews LS, Kaufer H. Resection arthroplasty as a salvage procedure for a knee with infection after a total arthroplasty. J Bone Joint Surg Am. 1987;69(7):1013–21. Epub 1987/09/01.

    PubMed  CAS  Google Scholar 

  52. Figgie III HE, Brody GA, Inglis AE, Sculco TP, Goldberg VM, Figgie MP. Knee arthrodesis following total knee arthroplasty in rheumatoid arthritis. Clin Orthop Relat Res. 1987;224:237–43. Epub 1987/11/01.

    PubMed  Google Scholar 

  53. Klinger HM, Spahn G, Schultz W, Baums MH. Arthrodesis of the knee after failed infected total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2006;14(5):447–53. Epub 2005/09/01.

    Article  PubMed  Google Scholar 

  54. Rand JA. Alternatives to reimplantation for salvage of the total knee arthroplasty complicated by infection. Instr Course Lect. 1993;42:341–7. Epub 1993/01/01.

    PubMed  CAS  Google Scholar 

  55. Somayaji HS, Tsaggerides P, Ware HE, Dowd GS. Knee arthrodesis—a review. Knee. 2008;15(4):247–54. Epub 2008/05/23.

    Article  PubMed  CAS  Google Scholar 

  56. Thornhill TS, Dalziel RW, Sledge CB. Alternatives to arthrodesis for the failed total knee arthroplasty. Clin Orthop Relat Res. 1982;170:131–40. Epub 1982/10/01.

    PubMed  Google Scholar 

  57. VanRyn JS, Verebelyi DM. One-stage debridement and knee fusion for infected total knee arthroplasty using the hybrid frame. J Arthroplasty. 2002;17(1):129–34. Epub 2002/01/24.

    Article  PubMed  Google Scholar 

  58. Wang CJ, Huang TW, Wang JW, Chen HS. The often poor clinical outcome of infected total knee arthroplasty. J Arthroplasty. 2002;17(5):608–14. Epub 2002/08/09.

    Article  PubMed  Google Scholar 

  59. Vlasak R, Gearen PF, Petty W. Knee arthrodesis in the treatment of failed total knee replacement. Clin Orthop Relat Res. 1995;321:138–44. Epub 1995/12/01.

    PubMed  Google Scholar 

  60. Fahmy NR, Barnes KL, Noble J. A technique for difficult arthrodesis of the knee. J Bone Joint Surg Br. 1984;66(3):367–70. Epub 1984/05/01.

    PubMed  CAS  Google Scholar 

  61. Stiehl JB, Hanel DP. Knee arthrodesis using combined intramedullary rod and plate fixation. Clin Orthop Relat Res. 1993;294:238–41. Epub 1993/09/01.

    PubMed  Google Scholar 

  62. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51. Epub 2009/06/26.

    Article  PubMed  Google Scholar 

  63. Wasielewski RC, Barden RM, Rosenberg AG. Results of different surgical procedures on total knee arthroplasty infections. J Arthroplasty. 1996;11(8):931–8. Epub 1996/12/01.

    Article  PubMed  CAS  Google Scholar 

  64. Enneking WF, Shirley PD. Resection-arthrodesis for malignant and potentially malignant lesions about the knee using an intramedullary rod and local bone grafts. J Bone Joint Surg Am. 1977;59(2):223–36. Epub 1977/03/01.

    PubMed  CAS  Google Scholar 

  65. Hankin F, Louie KW, Matthews LS. The effect of total knee arthroplasty prostheses design on the potential for salvage arthrodesis: measurements of volumes, lengths and trabecular bone contact areas. Clin Orthop Relat Res. 1981;155:52–8. Epub 1981/03/01.

    PubMed  Google Scholar 

  66. Schoifet SD, Morrey BF. Persistent infection after successful arthrodesis for infected total knee arthroplasty. A report of two cases. J Arthroplasty. 1990;5(3):277–9. Epub 1990/09/01.

    Article  PubMed  CAS  Google Scholar 

  67. Hinarejos P, Gines A, Monllau JC, Puig L, Caceres E. Fractures above and below a modular nail for knee arthrodesis. A case report. Knee. 2005;12(3):231–3. Epub 2005/05/25.

    Article  PubMed  Google Scholar 

  68. Harris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee. J Bone Joint Surg Am. 1990;72(10):1477–85. Epub 1990/12/01.

    PubMed  CAS  Google Scholar 

  69. Waters RL, Perry J, Conaty P, Lunsford B, O’Meara P. The energy cost of walking with arthritis of the hip and knee. Clin Orthop Relat Res. 1987;214:278–84. Epub 1987/01/01.

    PubMed  Google Scholar 

  70. Gurney B, Mermier C, Robergs R, Gibson A, Rivero D. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am. 2001;83-A(6):907–15. Epub 2001/06/16.

    PubMed  CAS  Google Scholar 

  71. Manzotti A, Pullen C, Deromedis B, Catagni MA. Knee arthrodesis after infected total knee arthroplasty using the Ilizarov method. Clin Orthop Relat Res. 2001;389:143–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA, 191074, USA

    Glenn J. Kerr M.D.

  2. Rothman Institute, Thomas Jefferson University, Sheridan Building, 10th Floor, 125 South 9th Street, Philadelphia, PA, 19107, USA

    Javad Parvizi M.D., F.R.C.S.

Authors
  1. Glenn J. Kerr M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javad Parvizi M.D., F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Glenn J. Kerr M.D. .

Editor information

Editors and Affiliations

  1. OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA

    Bryan D. Springer

  2. Rothman Institute of Orthopedics, Philadelphia, Pennsylvania, USA

    Javad Parvizi

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Kerr, G.J., Parvizi, J. (2014). Knee Arthrodesis. In: Springer, B., Parvizi, J. (eds) Periprosthetic Joint Infection of the Hip and Knee. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7928-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7928-4_17

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7927-7

  • Online ISBN: 978-1-4614-7928-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation