Salvage Knee Surgery: Arthrodesis

Primary arthrodesis or fusion of the knee is an uncommon procedure performed in the twenty-first century. It is rarely performed primarily for arthritis. The main role of knee arthrodesis is as a salvage procedure for an unrevisable failed total knee arthroplasty. In limb salvage surgery for malignant and potentially malignant lesions about the knee, resection arthrodesis using an intramedullary rod and local bone graft has been reported as a successful primary procedure. When performed as a primary procedure after trauma, arthritis, or instability, solid fusion may not always occur, with rates of union reported between 80 and 98% by various methods. Fibrous nonunion after attempted fusion frequently is painful, and rigid internal fixation promotes bony union. Using strict patient selection criteria, knee arthrodesis should be reserved as a salvage procedure for chronic infection, posttraumatic arthritis, periarticular tumor, or instability primarily following failed TKA.