Knee fusion 1Knee fusion 2




Salvage failed TKR / infected TKR


Charcot joint





Bilateral knee fusion

Ipsilateral hip fusion




Difficulty obtaining fusion

- often significant bone loss


Difficulties mobilising / sitting in small bathrooms




Short leg

- fuse straight 


Normal leg length

- fuse in 10° flexion for swing through


Valgus 5 - 7o


External rotation 5 - 10o




1.  Intramedullary nail

2.  Double plating

3.  External fixator






Luyet et al. KSSTA 2021

- 48 knee arthrodeses for failed TKA

- 21% reoperation rate for infection or nonunion

- eventual union rate 90%


Nail versus External fixation


Balato et al. BMC Musculoskeletal Disorder 2018

- systematic review of IMN versus external fixation for infected TKA

- 11% reinfection rate for IMN versus 5% for external fixation

- union rate 90% for IMN versus 88% for external fixation

- union 2 months faster with IMN


Fusion versus Above Knee Amputation (AKA)


Trouillez et al. Orthop Traum Surg Res 2021

- fusion versus AKA for infected TKA in 43 patients

- recurrent infection in 10% (2/20) AKA
- recurrent infection in 22% (5/23) knee fusion

- AKA group had less pain and better quality of life


Conversion Fusion to TKA


Jauregui et al. J Arthroplasty 2016

- 98 patients mean age 55

- revision rate 25%

- failure rate 11%


Kernkamp et al. Int Orthop 2016

- systematic review of six papers and 123 knees

- mean improvement in ROM of 80 degrees

- post-operative complication rate 65%

- 25% skin necrosis, 13% arthrofibrosis, 11% infection, 11% revision


Intramedullary nail




A.  Bridging nail

B.  Modular nail

C.  Long fusion nail


Bridging nail


Knee Fusion 1Knee fusion 2

Modular nail


Vumedi surgical technique



- single knee incision

- tibial and femoral components inserted through knee & then joined together

- different sizes for femur and tibia


Wichita Nail 1Wichita nail 2Wichita nail 3


Long fusion nail


Long fusion nail

Knee fusion 2




Insert through proximal femur


- femoral curvature

- knee valgus

- different intramedullary diameter between femur and tibia


Technique PDFs


Smith & Nephew Titanium Knee Fusion Nail

Stryker T2 Arthrodesis Nailing System


Dual plates


Knee fusion 3Knee fusion 4


Knee fusion 5Knee fusion 6


External Fixation


Knee Fusion External Fixation




Corona et al. Eur J Orthop Surg Traumatol 2020

- 29 cases end stage infected TKA

- biplanar external fixation eradicated infection and obtained union in 100% at 5 months

- uniplanar external fixation eradicated infection in 86% and obtained union in 81% at 10 months