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Procedure for Fused Knee Moves Patients to New Quality of Life

Dec 03, 2009

Patients are faced with possible limb amputation and grueling rehabilitation routine, but say it’s worth the risk and effort

Contact: Catherine Gianaro
cgianaro@weisshospital.com
(773) 564-7285

CHICAGO (Dec. 3, 2009)—Anthony Logan of Orlando, Fla., had walked as if he had a full cast on his left leg for the past 10 years. At age 31, he was involved in a motorcycle accident that resulted in severe damage to his left knee. After a series of surgeries and infections, doctors said all there was left to do was fuse his knee, which left Logan with no bend in his knee and a shortened leg, causing him to walk with a limp.

“I never took the stairs after the fusion,” said Logan, a construction electrician turned law student. “I also couldn’t go to the movies or sporting events, or share a roller coaster ride with my two young boys because there wasn’t enough room between seats for me to extend my leg without maneuvering my body in an uncomfortable way.” Driving was difficult for Logan too. And, as a result of contorting his body to adjust to daily living, he developed chronic back pain.

Logan said he had enough. After extensive online research with his wife, he found the only surgeon in the country willing to perform a surgical disassembly of his fused knee. He traveled to Chicago to hear what he was waiting to hear for a decade—the fused knee could be fixed, but he had to wait five years because of his young age, history of infection and extraordinary risks.

The disassembly of a fused knee is a rare procedure; only two to four of them are performed every year in the United States.

“The risks are high, so I tell my patients to think about it for at least a year,” said Henry Finn, M.D., chief of orthopedic surgery at Weiss Memorial Hospital, medical director of the University of Chicago Bone and Joint Replacement Center at Weiss, and professor of surgery at the University of Chicago. The biggest risk is loss of limb, either due to complications during surgery—neurologic and vascular in nature—or post surgery, due to infection.

“I was willing to accept losing my leg and living with the prosthetic,” Logan explained, adding that he also was prepared for the intense rehabilitation required after the procedure. Patients must be willing to endure the pain and time commitment it takes to retrain atrophied muscles how to move.

Because there are no functional ligaments in the area, the surgery requires a hinged knee implant with just enough rotation to recreate the natural tendencies of the joint. Finn used the Finn Knee System, an orthopedic prosthesis he designed for limb salvage and difficult knee surgeries (acknowledged by the American Academy of Orthopaedic Surgeons as one of the most notable inventions in its 75 years of existence). “It treats people with extensive bone and ligament damage as a result of deformity, trauma, revision, infection or cancer that a conventional knee replacement would not be able to accomplish,” Finn said.

Finn, who typically does a high volume of total joint replacement and joint revision procedures, performs the disassembly of the fused knee with great precision. He must cut the bone where the knee is fused, navigating arteries and nerves that control blood and movement in the lower extremities. If damaged during surgery, a patient could end up with temporary or permanent neurologic deficiencies below the knee.  To help avoid such injury, all patients have a pre-operative vascular evaluation, and a vascular surgeon is on-call during the procedure.

To help the soft tissue (made up of skin, fat, muscles, tendons and ligaments) enveloped around the knee—which in most cases is scarred and contracted—get around the prosthesis, a reduced size (RS version) implant is used. Logan had extensive ligament damage, so Finn had to delicately connect the upper and lower parts of the leg for stability. Logan was fortunate in that he still had his extensor mechanism (including his kneecap)—the muscles and tendons that straighten his knee. His age also was working in his favor. “I prefer these patients be older [in their 40s] because of the potential durability issue of this mechanical reconstruction,” Finn said.

So far, the Finn Knee System has proven to last as long as 20 years.

During the procedure, the implant is anchored by stems—one positioned in the femur (upper leg bone) and the other in the tibia (lower leg bone). “These stems are put in, so they don’t lock to the bone,” Finn said. “And if it gets infected, I can get it out.” During the surgery, Finn also was able to save Logan’s kneecap, which was fused to a bone.

Logan had a deformed anatomical femur from fractures and a history of infection, so Finn had to reshape the bone so the implant could rest in it. The procedure requires sacrificing bone that’s approximately four centimeters in length, which makes it nearly impossible to return to a fusion, leaving patients with the risk of amputation. Going into surgery, patients already have a shorter leg, usually an inch to three inches, so many of them wear lifts.

More than three months post-surgery, Logan is getting stronger by the day as he endures a rigorous rehabilitation routine. He no longer walks with a limp, and he now can use the stairs. He even recently taught his 4-year-old son how to ride a bike. He said he’s looking forward to returning to his more active days and interacting more with his sons. “Dr. Finn gave me my life back,” he said.

Logan also is encouraged by the lasting effects of the procedure on other patients like Stefanie Houser of Knoxville, Tenn. Five years after her disassembly of the fused knee, she says life couldn’t be better. “I’m pain-free, active and busy,” noted the co-owner of Knoxville’s popular Soccer Taco Mexican Sports Bars, who now can do such things as climb a ladder and get in and out of her car with ease.

At age 16, an auto accident left Houser with a dislocated right knee and ligament damage. After a string of surgeries over the years, doctors recommended she get her knee fused during college. After 18 years living with a stiff leg, Finn performed the fusion disassembly of her affected knee and reconstructed it by using a rotating hinge replacement (Finn Knee System). “She came to me at a younger age [compared to Logan], had no patella and no ligaments surrounding the knee to hold it in place, so the odds were against her,” Finn said.

Dedicated to rehabilitation for a quick recovery, Houser regained 120-degree flexion in her knee after four months. Her knee remains stable and all the pain she experienced in her hip and lower back as a result of overcompensating for her fused knee is gone.

Both Houser and Logan want other people with fused knees to know there’s hope for a better life and getting your bend back. For more information visit Weiss’ orthopedics program or call (800) 503-1234.