Name of the Procedure:

Arthrodesis, Knee
Common name: Knee Fusion
Technical/Medical term: Knee Arthrodesis

Summary

Arthrodesis of the knee, or knee fusion, is a surgical procedure where the bones of the knee joint are fused together to form one solid bone. This eliminates all motion at the knee joint but can provide stability and pain relief for patients with severe joint issues.

Purpose

Arthrodesis of the knee is primarily performed to address severe arthritis, infections, tumors, or when a total knee replacement has failed. The goal of the procedure is to relieve pain, provide stability, and enable the patient to bear weight on the affected leg.

Indications

• Chronic severe pain in the knee not relieved by other treatments
• Instability or deformity of the knee joint
• Severe arthritis, particularly when other surgical options are unsuitable
• Infection of the knee joint (septic arthritis)
• Tumors in or around the knee joint
• Failed total knee arthroplasty

Preparation

• Fasting for a specific period before the surgery (typically 8-12 hours)
• Adjustment or cessation of certain medications as advised by the physician
• Diagnostic imaging tests like X-rays, MRI or CT scans to assess the knee condition
• Blood tests and a pre-surgical clearance from a cardiologist or primary care physician

Procedure Description

1. The patient is given either general anesthesia or spinal anesthesia.
2. An incision is made over the knee to access the joint.
3. The damaged cartilage is removed from the femur and tibia (thigh and shin bones).
4. The bones are aligned and often a bone graft may be used to assist in the fusion.
5. Metal rods, plates, screws, or a combination of these are used to hold the bones together.
6. The incision is closed with sutures or staples.
7. A cast or brace may be applied to keep the leg immobilized during the initial healing phase.

Duration

The procedure typically takes 2-3 hours.

Setting

Knee arthrodesis is performed in a hospital or surgical center, often requiring an inpatient stay.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Nerve damage
• Nonunion or delayed union of the bones
• Leg length discrepancy
• Pain at the fusion site
• Adjacent joint arthritis

Benefits

• Significant pain relief
• Improved stability in the knee
• Ability to bear weight on the leg
• Prevention of further joint damage

Recovery

• Initial immobilization with a cast or brace for 6-8 weeks
• Physical therapy to strengthen muscles and improve mobility of adjacent joints
• Regular follow-up appointments to monitor healing via X-rays
• Gradual return to normal activities in 3-6 months
• Long-term restrictions may include avoiding high-impact activities

Alternatives

• Total knee replacement
• Partial knee replacement
• Osteotomy (bone cutting to realign the knee)
• Conservative management such as physical therapy, pain management, and joint injections
• Each alternative has its own risks and benefits which should be discussed with the healthcare provider.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel any sensation. Post-procedure, pain and discomfort are managed with medications. The patient will experience restricted movement initially, requiring assistive devices such as crutches or a walker. Pain and swelling gradually decrease, and physical therapy aids in recovery. Complete fusion and functional improvement are typically realized within 3-6 months.