General Considerations



General Considerations


Peter F. M. Choong



Complex reconstructive surgery is now commonplace for the knee as limb sparing surgery replaces amputation as the preferred technique for managing malignancies of the knee (1,2). Many of these techniques are also being extended to nonmalignant conditions (1,3,4,5,6,7) where significant bone loss and instability are dominant features such as with marked condylar bone defects associated with multiple revisions of a knee joint replacement or significant loss of bone integrity associated with periprosthetic fractures and also malunited or ununited fractures around the knee. The primary aim of reconstructive surgery is to achieve a stable mobile joint.




CONTRAINDICATIONS TO LIMB SPARING SURGERY


Infection

Infection may not only threaten the success of knee surgery, but may also lead to amputation if it becomes uncontrolled. Major reconstructive surgery must not be undertaken in the setting of infection unless it is being performed as part of a staged approach to the management of acute/chronically infected joint prostheses.


Skeletally Immature Patients

Mobile reconstruction following resection of osteosarcoma of the distal femur in patients with open growth plates may lead to the development of significant limb length inequality. Predicted inequality may be reduced by surgically restricting growth in the contralateral limb by epiphysiodesis. However, the potential for ongoing growth in the contralateral limb may be so great that interrupting this may result in unacceptable stunting of overall height. In principle, the younger the patient, the greater is the potential for limb length discrepancy. If the anticipated inequality is substantial, then reconstruction is contraindicated and amputation should be considered. Matching leg lengths through modification of amputation limb prostheses may be easier to achieve

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Jun 13, 2016 | Posted by in ORTHOPEDIC | Comments Off on General Considerations
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