Doctors turning to better implants to treat people with fused knees

It was a last resort that used to be done when nothing else could save a leg after injury or infection. Knee fusion eases the pain but also takes away a person's ability to bend their knee.

Now, new and better implants and surgeries have taken the place of many of these drastic procedures. For those who had the fusion years ago, there may be a way to undo the once permanent procedure.

Anthony Logan loves the rush.

"Being on a motorcycle is like a freedom that you can't describe,” Anthony Logan said.

He's back on his bike 10 years after a bad crash.

"My knee actually got caught between two motorcycles,” Anthony said.

Seventeen surgeries and a raging staph infection followed. At the time, doctors told him fuse it or lose it.

He had his knee fused. It’s a permanent procedure where two bones become one, and the knee doesn't 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,” Dr. Henry Finn, Medical Director at University of Chicago Bone and Joint Replacement Center said.

Dr. Henry Finn performs a risky surgery to un-fuse knees.

"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,” Dr. Finn said.

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.

"The saw must come through here and stop without injuring that artery,” Dr. Finn said.

Dr. Finn has done 50 operations. None of his patients have lost their leg. There was one case of infection. Dr. Finn discusses the risks with patients for at least a year before surgery.

Annette Czajkowski is considering it. She's lived with a fused knee for 30 years. Simply sitting is a chore.

"It's even hindered working. People don't want to hire you,” Annette Czajkowski said

For Anthony, the risk paid off.

He didn't just do it for himself. He did it for the little guys, a dad who can now get down on their level.

Knee fusions are still occasionally done in younger patients when an implant isn't an option because it will wear out too soon. Dr. Finn has a vascular surgeon standing by in case something goes wrong during the procedure.

Dr. Finn created and designed the mechanical knee that he implants in his patients.

RISKY SURGERY PUTS THE BEND BACK IN KNEES

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, PLEASE CONTACT:
Catherine Gianaro
Weiss Memorial Hospital
Chicago, IL
cgianaro@weisshospital.com
(773) 564-7285


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