Knee Arthrodesis with Internal Fixation
Michael Jubinville, MPH
Knee arthrodesis is a procedure that fuses the thigh bone to the lower leg bone at the knee. The joined bones may be secured with plates and screws. This method of support is called internal fixation. It provides support while the bones fuse together.
The knee will no longer be able to bend after this surgery.
Reasons for Procedure
Knee arthrodesis may only be done if all other repair methods have failed or are in appropriate. It may be done:
After a failed knee replacement
In patients with chronic joint infections that have led to severe knee damage
In patients with debilitating pain that cannot be resolved by other treatment options
Joint Damage Due to Arthritis
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Arthrodesis may reduce pain and improve overall function. However, it will prevent bending at the knee and will cause a limp.
Your doctor will review a list of possible complications, which may include:
Adverse reaction to anesthesia
Loosening of components in patients with poor bone quality
The thigh and shin bones do not join together as expected
Factors that may increase the risk of problems include:
Some chronic diseases, like obesity or diabetes
Heavy alcohol use
Make sure you talk to your doctor about these risks before your procedure.
What to Expect
Prior to Procedure
Your doctor may do the following before your procedure:
Imaging tests, like
Electrocardiogram for heart function
Have you donate blood in case you need a transfusion
Prescribe antibiotics to prevent infection
Before surgery, you will need to:
Arrange for a ride home.
Arrange for help at home while you recover.
Talk to your doctor about any medications, herbs, or supplements you are taking.
Talk to your doctor about any allergies you have.
Ask your doctor about devices you will need after the surgery like a wheelchair, walker, or cane.
You may need to stop taking some medications up to 1 week before the procedure.
Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
Description of the Procedure
An incision will be made over the knee. A small amount of bone from the ends of the thigh bone and top of the lower leg bone will be removed. Other knee joint structures like cartilage and ligaments or knee replacements will be removed. The ends of the bones will be joined together, usually with a bone graft. Metal plates will be screwed into the joined bones.
The incision will be closed. A bandage may be placed over the incision.
How Long Will It Take?
About 2 hours
Will It Hurt?
Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.
Average Hospital Stay
The usual length of stay is about 3-4 days. It is possible that you may have to stay longer if complications arise. You may also go to a rehabilitation hospital to help you recover.
At the Hospital
Right after the procedure, you may be given medication such as:
Antibiotics to prevent infection
Medication that prevents blood clots
Physical therapy often starts within 24 hours after your surgery. During this time you may need devices to help you walk.
You will be able to leave when you are able to get around and do basic daily care activities on your own.
When you return home, take these steps:
Follow your doctor’s instructions on sitting, bending, or sleeping positions.
Continue with your physical therapist’s exercise program.
Follow your doctor’s instructions.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
Signs of infection such as fever or chills
Problems at the incision site such as redness, swelling, pain, bleeding, or draining
Nausea or vomiting
Pain that does not go away with the pain medication you have been given
Numbness or tingling in the lower leg
Chest pain or trouble breathing
If you have an emergency, call for emergency medical services right away.
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org Canadian Resources:
The Arthritis Society
Canadian Orthopaedic Association
Bono James, Talmo Carl, et al. Arthrodesis of the Knee: Indications and Treatment Options.
Techniques in Knee Surgery. 2009;8(4):212-215.
Fusion (arthrodesis). Knee 1 website. Available at:
...(Click grey area to select URL) Updated October 26, 2001. Accessed February 9, 2018.
Knee Arthrodesis. Bone and Spine website. Available at:
...(Click grey area to select URL) Accessed February 9, 2018.
Surgical site infection-prevention. EBSCO DynaMed website. Available at:
. Updated October 3, 2017. Accessed February 9, 2018.
Talmo CT, Bono JV, et al. Intramedullary Arthrodesis of the Knee in the Treatment of Sepsis after TKR.
HSS J. 2007;3(1):83-88.
Last reviewed March 2018 by
EBSCO Medical Review Board
Warren A. Bodine, DO, CAQSM Last Updated: 6/24/2013