KNEE ARTHRODESIS IN THE YOUNG TRAUMA PATIENT

Abstract

Introduction: Historically, arthrodesis of the knee was accepted as a primary procedure in patients with extensive joint destruction, usually in the elderly arthritic population. Since the significant advances in arthroplasty, knee arthrodesis has mainly become an uncommon salvage procedure for failed and infected arthroplasty. However, when all other surgical options in reconstruction post-trauma have failed, arthrodesis remains an alternative to amputation.

Patients and Methods: Six patients who had unilateral knee arthrodesis with the Ilizarov frame for traumatic destruction of their knee were assessed by physical examination, radiology review and clinical questionnaires.

The Lower Extremity Functional Scale (LEFS) and the AMA Criteria for Impairment Associated with Station and Gait Disorders were used to evaluate their functional levels of impairment. The Short-Form-36 (SF-36) Health Survey was also used as a general survey of their health.

Results: The patient group ranged from 24 – 47 years of age (mean 32.5 years), and are between 1 – 10 years after unilateral knee arthrodesis. All were satisfied with the outcome of their procedure, and half are able to work full time. 80% of those who drive report actually driving while being treated with the Ilizarov frame. Those who score lowest on the SF-36 also had significant other post-trauma injuries (e.g. upper limb amputation). Significantly, while the average level of whole person impairment was 10–19%, patients perceived their ability to walk on the flat as normal, and only have mild difficulty in rising to stand.

Conclusion: Knee arthrodesis is a realistic and acceptable alternative to amputation, and is therefore an option which should be offered to patients in the non-acute setting. It has successfully enabled salvage of otherwise “unsalvageable” limbs in our young patient group.