On-line version ISSN 2309-8309
Print version ISSN 1681-150X
SA orthop. j. vol.8 n.3 Pretoria Jan. 2009
F FranceschiI; J OkelloII; A LoroI
IMD; Orthopaedic Surgeon, Children's Orthopaedic Rehabilitation Unit, Mengo Hospital, Kampala, Uganda
IIMD;Orthopaedic Surgeon, Orthopaedic Department, Mulago Hospital, Kampala, Uganda
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.
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Dr Antonio Loro
PO Box 22831
Tel: (00256) 0414-501038 or (00256) 078 2255 281
The authors state that no benefits of any form have been received from a commercial party related directly or indirectly to the subject of this article. Furthermore they state that all the subjects enrolled in this study have given informed consent and that the ethical committee of their institution approved the study.