On-line version ISSN 2309-8309
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.
“Full text available only in PDF format”
1. Franceschi F. Paediatric Orthopedics in Africa. Our experience in Uganda (unpublished data). [ Links ]
2. Rozbruch SR, Blyakher A, Helfet DL, Warren RF. Knee arthrodesis and simultaneous leg lengthening using the Ilizarov method. http://www.limblengthening.com/news/ABS-kneearthrodesis.html. [ Links ]
3. Laurenteeva-Ilizarova SG. Correction of knee deformity with simultaneous lengthening in patients with sequelae of haematogenous osteomyelitis of the distal end of the femur. PhD thesis, Kurgan, 1987. [ Links ]
4. Damsin JP, Ghanem I. Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. JBJS (Br) 1995;77-B:140-4. [ Links ]
5. Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop 1990;250:8-26. [ Links ]
6. Kerri O, Martini M. Tuberculosis of the knee. Int Orthop 1985;9:153-7. [ Links ]
8. Castro S, Absi AY. Ilizarov technique for management of infected non-union of proximal tibia by knee joint arthrodesis and simultaneous leg lengthening. 2002, www.ilizarovjordan.com/press2.html. [ Links ]
9. Carnesale PG. Arthrodesis of ankle, knee and hip. In: AH Crenshaw (ed) Campbell's Operative Orthopaedics. MosbyYear Book 1992:315-52. [ Links ]
10. de Pablos J, Barrios C, Canadell J. Leg lengthening by distraction through the callus of an arthrodesis. JBJS 1991;73-B:458-60. [ Links ]
11. Said CZ, El-Sherif EK. Resection-shortening-distraction for malignant bone tumors. A report of two cases. JBJS 1995;77-B:185-8. [ Links ]
12. Tomak Y, Piskin A, Gulman B, Tomak L. Treatment of U-shaped ankylosis of the knee with the Ilizarov method. JBJS 2005;87-A:1104-7. [ Links ]
13. Neumann HS. The pin track infection. In: W.Klein, H.Neumann, E.Brug (eds). Dynamic axial external fixation. Verlag GMBH Munich 1996;229-36. [ Links ]
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.