FUSION OF THE KNEE JOINT IN CASES OF CHARCOT'S DISEASE

Report of Four Cases

¹ The clinic of the New York Orthopaedic Dispensary and Hospital and Seaview Hospital, New York City.

In the four cases here presented in which the operation was done, solid bony fusion resulted in three and the results were very satisfactory, i.e., the patients were able to walk without a brace or other support and had no instability in the knee. It is interesting also to note that firm union was present in one at four months, in another at five and one-half months, and in the third at six months. This compares very favorably with cases in which the fusion operation was done for other conditions,—such as tuberculosis; stabilization of the knee in poliomyelitis, etc. Not a little doubt was felt as to the possibility of obtaining bony fusion in a Charcot joint. Although this series is too small to justify any general conclusions, the results are sufficiently encouraging to warrant trying the operation in other selected cases.

The fourth case, in which fusion did not take place and in which the wound broke down with the formation of sinuses, undoubtedly was too far advanced and should not have been operated upon. The patient's general condition was poor and, in addition to involvement of both knees, there was partial destruction of the metatarsal bones of one foot and a trophic ulcer.

The technique used in these operations was that described by Hibbs for stabilization of the knee in poliomyelitis, and afterwards employed for any condition in which arthrodesis of the knee is indicated, modified somewhat to meet the peculiar circumstances of each case. Weight-bearing in plaster was allowed at the end of six to eight weeks.

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