Bilateral Bony Fused Knees

Restoring mobility after a successful Total Knee
Replacement Surgery

THE CASE

A 39-year old healed (burned out) Rheumatoid Arthritis patient came to Nanavati Super Speciality Hospital, with bilateral 90 degree bony fused knee joints. There was no movement in both the knees while her spine, both hips and ankles were mobile. She also had associated hand deformities. Other than this, there was no significant co-morbidities. She was wheelchair bound for eleven years. Her X-ray showed bilateral bony continuity of femur with tibia (knee joint).

THE PROCEDURE

In pre-operative planning, the blood vessels, nerves and the bony fusion mass was dissected and safely resected at the joint line. Since there was flexion / extension gap mismatch of more than 10 mm, Nexgen Rotating Hinge TKR (Zimmer USA) was implanted which corrected the deformity from 90 degree to 30 degree on the operation table. Expertise in handling such cases led the team of doctors to wait, as such residual deformities can be gradually corrected using a splint. In this case, the residual 30 degree of flexion deformity was progressively corrected to full correction in over four weeks using push knee splint. On successfully correcting one knee, the other knee was operated after an interval of six weeks, resulting in bilateral straight knee.

THE RESULT

Four years post operation the patient has excellent mobility, stability and function. She has gained 0 to 110 painless stable active movements. Now she can walk, climb stairs, sit on chair and get up unaided independently. After eleven years of wheelchair-bound life, she has started to walk independently.

Dr. Pradeep B. Bhosale
Director, Arthritis & Joint
Replacement Surgeries
Orthopaedics & Joint
Replacement
Nanavati Super Speciality
Hospital, Mumbai