Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 8, pp 1940–1948 | Cite as

Arthrodesis of the knee following failed arthroplasty

  • P. J. H. Van Rensch
  • G. J. Van de Pol
  • J. H. M. Goosen
  • A. B. Wymenga
  • F. H. R. De Man



Primary stability in arthrodesis of the knee can be achieved by external fixation, intramedullary nailing or plate fixation. Each method has different features and results. We present a practical algorithm for arthrodesis of the knee following a failed (infected) arthroplasty, based on our own results and a literature review.


Between 2004 and 2010, patients were included with an indication for arthrodesis after failed (revision) arthroplasty of the knee. Patients were analyzed with respect to indication, fusion method and bone contact. End-point was solid fusion.


Twenty-six arthrodeses were performed. Eighteen patients were treated because of an infected arthroplasty. In total, ten external fixators, ten intramedullary nails and six plate fixations were applied; solid fusion was achieved in 3/10, 8/10 and 3/6, respectively.


There is no definite answer as to which method is superior in performing an arthrodesis of the knee. Intramedullary nailing achieved the best fusion rates, but was used most in cases without—or cured—infection. Our data and the contemporary literature suggest that external fixation can be abandoned as standard fusion method, but can be of use following persisting infection. The Ilizarov circular external fixator, however, seems to render high fusion rates. Good patient selection and appropriate individual treatment are the key to a successful arthrodesis. Based upon these findings, a practical algorithm was developed.

Level of evidence

Retrospective case series, Level IV.


Knee arthrodesis Infection Failed arthroplasty Algorithm 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • P. J. H. Van Rensch
    • 1
  • G. J. Van de Pol
    • 1
  • J. H. M. Goosen
    • 1
  • A. B. Wymenga
    • 1
  • F. H. R. De Man
    • 2
    • 3
  1. 1.Department of OrthopedicsPostoperative Joint Infection UnitNijmegenThe Netherlands
  2. 2.Department of OrthopedicsVlietland HospitalSchiedamThe Netherlands
  3. 3.Department of OrthopedicsOrthopediumDelftThe Netherlands

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