Abstract
Osteoarticular loss in a major weightbearing joint is one of the many consequences of military conflict. While minor in terms of life and limb salvage, when rehabilitation is being planned, a small amount of joint damage can make a large impact on the level of long term disability. Reconstruction methods include allograft, massive replacement, arthrodesis and amputation.
We have been developing a suite of technologies that contribute to the reconstruction of such injuries including assessment of disability in a fully instrumented gait lab, modelling of the injury using low dose CT, analysis of the extent of loss and creation of stereolithograph files of the bones, planning of the surgical procedure including implants as needed, custom manufacture of osteotomy guides and prostheses if required and technology assisted surgery, including active constraint robots.
We report 3 cases of soldiers who have suffered osteoarticular loss to part of the knee, two from high velocity rounds and one from an IED. All 3 have received custom partial knee replacements preserving their cruciates, the other compartment and the patella-femoral joint.
No major technical issues have been encountered. The surgery is quick and recovery simple, with the prospect of normal painfree pedestrian life. Exchange of the bearing will be necessary. It is expected and planned for once a decade as a day case procedure. While the surgery is expensive, it is highly cost-effective, as it restores near normal gait. It does not appear to be particularly risky, as the volume of tissue being excised is small, and highly constrained. The same approach is now being developed for deployment in civilian life for post traumatic osteoarthritis.
