My surgeon has started talking to me about possibly having a knee fusion. I’m way too young for a joint replacement. But I’m also in way too much pain to keep on like this for another 20 or 30 years. I have heard that some people love their fusion and others hate it. What are the ups and downs of this operation?

Before considering a fusion, there are two other possible options. You may want to ask your surgeon if you are a candidate for either one. The first is an osteotomy. Osteotomy refers to the removal of a wedge-shaped piece of bone from one side of the knee. The remaining bone is moved to fill in the area where the wedge was removed. This procedure helps realign the bones and joint and redistribute weight and load.

This is a corrective procedure. It is used most often in younger adults to unload one side of the joint that is bearing the brunt of the burden. Arthritis affecting just one side of the knee joint is called unilateral or single-compartment degenerative disease. By unloading the side affected by arthritis the most, the knee can be spared much longer. Osteotomy buys the patient time before a total joint is needed.

Patients who benefit from osteotomies usually had a fracture around the knee that resulted in a leg length difference. Malunion or deformity after fracture or ligamentous healing can be treated with an osteotomy. The technique allows the surgeon to restore a more normal mechanical axis (center) of movement while spreading out the forces across the entire joint surface.

There’s an alternate surgical procedure that can be done when osteotomy isn’t enough or isn’t possible in the young patient. That’s an allograft transplantation. Bone from a donor or bone bank is used to replace bone lost. The transplanted bone dies but the body generates new blood to the area and forms its own bone to replace the allograft. Over a period of months to years, the body fills in with its own bone.

When none of these salvage procedures can be done, the surgeon may have to fuse the joint. This is called an arthrodesis. A fusion allows the patient to bear weight and walk on the involved leg. Of course, there are some problems with walking stiff legged.

It’s hard to get dressed when you can’t bend your knee. Putting on shoes and socks, cleaning the foot, cutting the toenails, even getting up from a chair or toilet can be difficult. And eventually, the hip and back start to hurt because of the altered biomechanics and movement. If you already have back pain, this may not be the way to go.