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* The most common indication for arthrodesis of the knee is an infection at the site of a total knee arthroplasty.
* Deficiencies in bone stock and poor bone apposition adversely affect the success of a knee arthrodesis.
* Arthrodesis of the knee can provide a stable, painless extremity for high-functioning patients who are able to walk.
* Patient function after arthrodesis of the knee is superior to that after above-the-knee amputation.
* Conversion of a solid knee fusion to a total knee arthroplasty has a substantial complication rate.
Arthrodesis of the knee has been performed since the early 1900s to treat the pain and instability associated with advanced osteoarthritis, posttraumatic arthritis, Charcot arthropathy, infectious arthritis, poliomyelitis, and reconstruction following tumor resection1-10. Currently, the indications for knee arthrodesis have been narrowed for multiple reasons. Poliomyelitis has been virtually eliminated by vaccination. Improved antimicrobial therapy for patients with tuberculosis and syphilis has almost eliminated knee involvement by these diseases. In addition, the success of modern knee arthroplasty has substantially decreased the number of patients who formerly would have been candidates for a knee arthrodesis. Presently, the most common indication for a knee arthrodesis is pain and instability in an unreconstructable knee following an infection at the site of a knee arthroplasty (Figs. 1-A and 1-B)11-17. In addition, knees with substantial metaphyseal bone loss, inadequate ligamentous restraints, multiple failed revisions, inadequate soft-tissue coverage with loss of the extensor mechanism, and infection with virulent organisms should be considered for arthrodesis. This review will focus on these modern indications for knee arthrodesis; the operative techniques, results, and complications of the procedure; and alternatives to knee arthrodesis. The controversies surrounding conversion from a solid fusion to a total knee replacement will also be reviewed.
Indications for Knee Arthrodesis
Knee arthrodesis is indicated for pain and instability of the knee in a young, vigorously active patient who has had a reconstruction following tumor resection, has post-poliomyelitis syndrome, or has Charcot gonarthrosis. Historically, arthrodesis was indicated for young patients with posttraumatic arthritis. Total knee arthroplasty formerly was complicated by early failures and high rates of revision16, but recent reports have demonstrated success rates ranging from 86% to 96% (in series ranging from thirty to fifty-two patients, with durations of follow-up of...