SA Orthopaedic Journal
On-line version ISSN 2309-8309
FRANCESCHI, F; OKELLO, J and LORO, A. Simultaneous joint fusion and limb lengthening for knee deformities in children: A one-stage procedure The Kampala experience. SA orthop. j. [online]. 2009, vol.8, n.3, pp. 47-52. ISSN 2309-8309.
BACKGROUND: Delay in the treatment of septic or tuberculous arthritis of the knee often results in a painful and stiff joint, mainly in a position of flexion. Often limb shortening is also present. A clinical study was undertaken to see what the long-term results of a one-stage procedure is, whereby an external fixator is used to achieve fusion of the knee and limb equalisation simultaneously by means of distraction of the callus at the arthrodesis site. METHOD: Seven children, with a mean age of 13.5 years at presentation, were included in this study. Four children had septic arthritis and three had tuberculosis. All children had the same procedure. The deformity was corrected and an Orthofix device applied. After seven days, distraction of the arthrodesis site was started and continued until the desired length was obtained. Screw replacement was necessary in five cases due to pin-track infection. RESULTS: A stable, painless, well-aligned limb was obtained in all the patients and they were able to walk unsupported. Complete correction of limb length discrepancy was obtained in five patients and partial correction in the remaining two cases. CONCLUSION: Knee arthrodesis is a suitable option for managing severe deformities in children and young adults as it results in a stable and painless limb and eliminates the use of walking aids. In cases where leg length discrepancy is also present, the fusion can be achieved simultaneously with the equalisation process. Our experience has shown that this is a worthwhile clinical procedure which can result in a marked improvement in the quality of the life of these children.