Total Knee Replacement vs Knee Fusion for Severe Arthritis

[geminigirl1963]

I had a rather unnerving appointment with my orthopedic surgeon yesterday.  I've got severe arthritis in all my joints and already have had a shoulder replacement a little over a year ago. My appointment yesterday was for my knees, in particular, my left knee.  We have tried PT, water therapy, anti inflammatories (which I recently discoverd I cannot take due to them raising my blood pressure to a very dangerous level), narcotic pain medication, muscle relaxers, cortisone injections, heat, ice, and yesterday I received a Euflexxa injection (similar to Synvisc, but made with non-avian materials as I am allergic to feathers so cannot use Synvisc).  My doctor has plain out told me that I have 100% bone on bone arthritis and I definitely need to have surgery sooner rather than later.  He told me that due to my age (I'm only 46) and having some other health issues (lupus, fibromyalgia, asthma), he would strongly suggest going with a total knee FUSION as opposed to a total knee REPLACEMENT.  He said that because I am relatively young (although I don't feel young most days) and have the autimmune problems, there is an increased chance that a knee replacement would not last very long for me and would have to be done at least one more time, if not several times.  He stated that with a knee fusion, pain is elminated because of course the knee doesn't move, being able to cause pain.  He also said that the knee fusion has a much higher rate of success for someone at my age and health issues than the replacement.  
Has anyone else had a knee fusion?  What were the results and how does it affect your life and ability to remain independent, including driving?  This doctor wants me to follow up with the surgeon who did my shoulder surgery (he's at a larger hospital), so I'll be doing that, but wanted some other opinions on this subject.  Thank you.

[Abhijeet Ghosh]

Dear Robyn,
1) Before knee fusion, would you recommend trying a replacement?  Then if there is a failure of the replacent go to the fusion?  Or vice versa?  Or is this something is is even possible?
             If money in not a problem and you are ready to take a big chance of re-surgery, we can try to Knee replacement.If it fails or gets infected,fusion can always be done.Vice Versa is not possible.However if it gets infected, things would get much complicated.
2) Since I have the arthritis in all of my joints, including my right knee, how much more stress will a fusion be putting on my right knee because of having to adjust my walking gait to accomodate the fused knee?  Is there any difference between this amount of stress to my "good" knee between a fusion and a replacement?  Obviously I don't want to end up having to have a fusion in both knees, and I have definitely noticed since I've been having more trouble with my left knee that my right knee is starting to act up more and I'm sure part of it is because of favoring my left leg.
         Well you will surely have more stress diverted to your normal knee.Joints dynamics is same as Mechanical Dynamics.If your one car tyre is having low air, the effect will be seen in all the 4 tyres and they would get burned out quickly.Same is applicable for the joints also.

3) What are the recovery times and post op therapy differences between replacement and fusion?  With my shoulder replacement, I was in an immobilizer for six weeks following surgery and then several months of PT.  I don't have a problem with the post op therapies, was just wondering if with a fusion there is still the long months of PT since the knee doesn't bed so you obviously can't exercise it.
                For fusion, joint movements is not possible. Rehabilitation will aim at lifestyle modification.For knee replacement , the protocol will be almost identical to the shoulder rehabilitation, except the fact that knee range of motion will start from the second day of the surgery.

4) Not related to the knee issue, but rather my shoulder that was replaced - is it possible to do a fusion on a shoulder also?  I'm having a great deal of problems with my affected shoulder over the past couple of months and more so the past two weeks and greatly fear that the replacement has failed.  Before going through another replacement, I may consider a fusion to that joint if it is something that is possible/realistic
                           Shoulder fusion (Scapulothoracic) is one of the most successful fusion surgeries.
Feel free to ask more for further clarification.Would appreciate you to post as a new question this time.
Regards

[geminigirl1963]

Thank you for your quick response to my questions.  I do have some more questions if you don't mind.

1) Before knee fusion, would you recommend trying a replacement?  Then if there is a failure of the replacent go to the fusion?  Or vice versa?  Or is this something is is even possible?

2) Since I have the arthritis in all of my joints, including my right knee, how much more stress will a fusion be putting on my right knee because of having to adjust my walking gait to accomodate the fused knee?  Is there any difference between this amount of stress to my "good" knee between a fusion and a replacement?  Obviously I don't want to end up having to have a fusion in both knees, and I have definitely noticed since I've been having more trouble with my left knee that my right knee is starting to act up more and I'm sure part of it is because of favoring my left leg.

3) What are the recovery times and post op therapy differences between replacement and fusion?  With my shoulder replacement, I was in an immobilizer for six weeks following surgery and then several months of PT.  I don't have a problem with the post op therapies, was just wondering if with a fusion there is still the long months of PT since the knee doesn't bed so you obviously can't exercise it.

4) Not related to the knee issue, but rather my shoulder that was replaced - is it possible to do a fusion on a shoulder also?  I'm having a great deal of problems with my affected shoulder over the past couple of months and more so the past two weeks and greatly fear that the replacement has failed.  Before going through another replacement, I may consider a fusion to that joint if it is something that is possible/realistic.

Again, thank you for your help - the information you've already provided was very helpful and definitely put me at ease as far as knowing my doctor wasn't totally nuts suggesting this!! :)

Robyn

[Abhijeet Ghosh]

Dear Geminigirl,
Many thanks for asking the questions.
1) Has anyone else had a knee fusion? - Yes, i  have doe it on many of my patients.
2) What were the results and how does it affect your life and ability to remain independent, including driving? - The knee is fused in 5-10 degrees of flexion. By knee fusion the surgeon will eliminate your knee movements so your knee will be always straight.You will never be able to bend it again. You will have to undergo lifestyle modification.Driving will be a difficulty,unless your car is really big one,where you will be able to accommodate the straight knee.Sitting on a high chair won't be of much concern for you in a fused knee.

The main reason of fusion is that ,the artificial joint lasts for 20-25 years maximum.So chances of re-surgery are high.Also a metal inside your body, will make you prone for infections.So i would agree with him.
Feel free to ask more.
Regards