Knee Arthrodesis in the Infected Total Knee Arthroplasty

Knee arthrodesis is a limb salvage option for complex periprosthetic joint infections where revision total knee arthroplasty (TKA) is no longer reasonable. We will review the development of knee arthrodesis and examine its place alongside permanent resection arthroplasty and above-knee amputation (AKA) for treatment of the infected TKA. Indications and contraindications are discussed before the fundamental principles of perioperative management, with an emphasis on radical debridement as the most important step in achieving successful infection clearance. Knee fusion may be performed using external fixators in mono- or multiplanar configurations, internal compression plating, and long or short modular or non-modular intramedullary nails. Alternatively, bridging implants derived from endoprostheses may be used to overcome significant bone defects. There are certain advantages and disadvantages specific to each method of fixation, which should be considered prior to surgery. The evidence and outcomes reported in the literature with respect to these are reviewed, before we mention some post-operative considerations and strategies that may help to improve outcomes in the future.