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Knee Arthrodesis with Internal Fixation

knee AR-throw-DEE-sis

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

Knee arthitis

Joint Damage Due to Arthritis

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:

  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets

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. A small amount of bone from the ends of the thigh bone and top of the lower leg bone will be removed. Other knee joint structures like cartilage and ligaments or knee replacements will be removed. The ends of the bones will be joined together, usually with a bone graft. 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 3-4 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.
  • Continue with your physical therapist’s exercise program.
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_Center/Therapies/Fusion_Arthrodesis. Updated October 26 Updated October 26, 2001. Accessed January 16, 2013.

Hospital Admission and Your Medications Before Surgery. http://www.keggiorthosurgery.com/Hospital_Admission_And_Your_Medications.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_Hip_And_Knee_Surgery.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.



Last reviewed June 2013 by Michael Woods MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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