ABSTRACT
Knee arthrodesis has been performed since the early 1900s for a variety of indications, most commonly advanced osteoarthritis and infectious arthritis (1-10). Today, however, the most common indications for knee arthrodesis are trauma where the joint is no longer salvageable or following total knee arthroplasty (TKA) infections. Charnley’s results with knee arthrodesis for osteoarthritis are impressive (11). The majority of patients returned to work within 12 weeks without a brace. Today, knee arthrodesis is considered a procedure of ‘‘last resort’’ or ‘‘better than an amputation.’’ This thinking, along with the many revision total knee options and tumor prostheses available, has made successful knee arthrodesis quite a challenge. The typical patient presenting for a knee arthrodesis has experienced as many as three revisions and numerous surgical procedures to preserve knee motion. The patients are typically over 70 years of age with multiple medical problems including osteoporosis. These patients also have a loss of soft tissue anteriorly, as well as no extensor mechanism, with exposed bone and significant bone loss (> 4 cm). Although Charnley’s study found that patients recovered within 12 weeks, complications such as loss of soft tissue and infection will significantly extend the time to bone union well beyond 12 weeks. With the aging population and the popularity of TKA, the number of patients requiring a knee arthrodesis certainly will increase. The remainder of this chapter will focus upon the clinical evaluation, classification, treatment options, surgical techniques, and complications of knee arthrodesis.
