HealthFirst reporter Leslie Toldo says new and better implants and surgeries have taken the place of many of these drastic procedures.
For many who had knee fusion surgery years ago, there may be a way to undo the once-permanent procedure, but it's a risky surgery.
Anthony Logan loves the rush of being on two wheels. "Being on a motorcycle is like a freedom that you can't describe."
He's back on his bike 10 years after a bad crash. "My knee actually got caught between two motorcycles."
Seventeen surgeries and a raging staph infection followed. At the time,
doctors told him to fuse it or lose it.
He had his knee fused. It was a permanent procedure that joined two bones into
one, making it impossible for the knee to bend.
"It's kind of like an appendage that works as a peg leg and is there, so you can ambulate. But pretty much for everything else, it's always in the way," explained Dr. Henry Finn.
Finn performs a risky surgery to un-fuse the knee. "They have to be willing and accept the risk of loss of their limb, and be so desperate not to keep the fusion that they would accept that."
He cuts through the fused bone and implants a mechanical joint. The stems that anchor it extend almost from the hip to the ankle. The saw comes dangerously close to the major artery and nerve.
Finn has done 50 operations. None of his patients have lost a leg, but there was one case of infection.
Finn makes it a point to discuss the infection risks with patients for a year before surgery.
Annette Cjajkowski is considering the surgery. She's lived with a fused knee for 30 years. "It's even hindered working. People don't want to hire you," she said.
For Logan, the risk paid off. He didn't do it just for himself, he did it for his sons as well.
BACKGROUND: Bone or joint fusion surgery, called arthrodesis, is performed to
relieve pain in the hips, knees, ankles, wrists, fingers, thumbs or spine. In
the surgery, two bones on the end of a joint are fused, eliminated the joint
itself. It's used in patients whose joints have eroded or have been destroyed by
osteoarthritis, rheumatoid arthritis, trauma or infection. It forces the joint
to lose flexibility, meaning the person can't bend his/her knee, wrist or ankle.
However, there are benefits including the joint can bear weight better, it's
more stable and it is no longer painful. At one time, fusion was considered the
best permanent treatment for people whose joints were severely damaged. However,
as new, more-advanced, longer-lasting joint implants become available, surgeons
now only look to fusion in rare cases as a last resort. "Knee fusion continues
to be done but less frequently, partly because of the modern-day limb salvage
for non-cancerous problems and because of the development of new and better
implants and surgical techniques," Henry Finn, M.D., Medical Director of the
University of Chicago Bone and Joint Center at Weiss Memorial Hospital, told
Ivanhoe. "Historically, it was done in situations where a knee was so badly
damaged either by trauma, tumor, deformity, severe arthritis or infection, and
particularly, infection after knee replacement," said Dr. Finn.
LIVING WITH A FUSED KNEE: A knee fusion greatly limits mobility and flexibility.
Even sitting can be difficult. Since one leg doesn't bend, it points straight
out as opposed to having the foot on the ground. "Going to the bathroom is hard,
driving a card is hard, taking public transportation is rough, being around
children is difficult if you have your leg out they want to sit on it. It's even
hindered working. People don't want to hire you," Annette Czajkowski, who has
lived with a fused knee for 30 years, told Ivanhoe.
UN-FUSING KNEES: Dr. Finn is one of the few doctors in the country who is
un-fusing knees. It is a risky procedure that includes the risk of amputation.
"They have to be willing and accept the risk of loss of their limb and be so
desperate not to keep the fusion that they would accept that, and they have to
be willing to commit to an intensive rehab program to make it worth it," said
Dr. Finn. Dr. Finn uses a saw to cut the fused bone and has to come dangerously
close to a main artery in the leg. "We put a saw that is battery controlled and
strong enough to cut a wall down through the bone at the level we want to put
the joint in. "The joint has to be put in, and we have to cut the bone but not
cut the major arteries and nerves that nourish and keep the leg alive and
functional, and that's the critical moment where a limb could be lost," said Dr.
Finn. Finn has performed 50 of these surgeries and hasn't had any patient lose
limbs. There has been one case of infection. The implant that Dr. Finn puts in
has rods attached that stretch from hip to ankle. The knee joint is flexible and
allows the patient to bend after months of rehab. Dr. Finn says he talks with
his patients about the risks for years before the surgery to make sure they
understand both sides.
FOR MORE INFORMATION:
Catherine Gianaro
Weiss Memorial Hospital
Chicago, IL
cgianaro@weisshospital.com
(773) 564-7285
