Knee Arthrodesis With Prosthetic Or Biological Solution

In some cases of bone tumors and severe trauma, failure of prostheses or osteosynthesis can represent a significant challenge. It is in this scenario that knee arthrodesis emerges as a viable alternative. This technique can be performed in several ways, one of which is with a diaphyseal-type prosthesis or through a biological solution using autologous graft and osteosynthesis.

For example, when we are faced with the failure of an infected primary prosthesis or in situations of aggressive bone tumors or trauma, arthrodesis can become an alternative to amputation.

Let us consider this case of recurrent chondrosarcoma, after two unsuccessful surgical attempts, in which the need for a wide resection is present, and reconstruction with arthrodesis may be the only alternative to avoid amputation. In these cases, arthrodesis using a diaphyseal prosthesis may offer the chance of preserving this limb.

Success requires careful resection, with the removal of compromised tissues, preserving the popliteal vessels and nerves in the region. Then, reconstruction is carried out with a modular prosthesis of the diaphyseal type, in this case it was specially molded, with the manufacture of a polyethylene segment, aiming to give a more aesthetic shape to the “neo knee” region, minimizing the defect left by the extensive resection of the segment affected by the tumor and meeting the objective of ensuring a wide resection, with safe oncological margins.

In this other example of a giant cell tumor, which destroyed the entire tibial plateau and the proximal 1/3 of the tibia, the approach may be biological. In this patient, we used autologous bone from the site itself, in the case of the femoral condyles, to fill the bone gap left by the resection of the neoplasm.

It is important to highlight that the technique requires precision and care, both in resection and reconstruction. The plate used for fixing must be positioned to ensure adequate alignment and avoid unwanted rotations. The integration of arthrodesis with the biological autograft is essential for the success of the procedure.

In cases of severe trauma, with extensive bone destruction due to high-energy trauma, arthrodesis may be the only viable option to restore limb stability and avoid amputation. These cases, which we are showing, were presented at the International Knee Trauma Congress, in Ribeirão Preto – SP, showing our experience with these two arthrodesis techniques, using diaphyseal prostheses or osteosynthesis with biological reconstruction. For more information about these techniques and appreciation of other similar clinical cases, visit the website  www.oncocirurgia.com.br ,

 By sharing knowledge and experience, we will be able to advance developments in the treatment of complex orthopedic conditions.