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Author Topic: fused knee reversal  (Read 3481 times)

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Offline alexandra531

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fused knee reversal
« on: August 26, 2013, 07:25:42 AM »
Hi, I'll start with the story of how I got my knee fused. In 2010 at 16 years old, I was in a car wreck that broke my femur, and tibia, cut my foot almost completely in half, and killed most of the skin on my left leg. Somehow in the whole ordeal, a chunk of bone about the size of a walnut was knocked out of the bottom of my femur where it would attach to my lower leg. After 20 surgeries (most of which being skin grafts) and 3 months in a hospital bed, it came time for my ortho to decide what he was going to do with my knee. He told me that he could replace the missing bone with a donation from a cadaver, and repair my mcl with cadaver tendon (which he never failed to tell me would be a risky operation with chances of rejection and long recovery) or he could fuse my knee joint and I could be on the road to recovery much sooner. As a sixteen year old girl I wanted to put this all behind me as soon as I could, and opted for the fusion. Now I'm 19 and I'm tired of living like this. I can't bend my knee, so I can't enjoy almost anything I used to love to do. What bothers me more than anything else though, is my inability to run. I knowthis is not going to fix all my problems, and it will take a tremendous amount of dedication to get even close to normal, but it would all be worth it for me to be able to act and feel like a normal person again. I just want to know if anyone here has had a knee fusion reversed, and a doctor they might recommend for such a procedure. I know my case is quite different than most, but this is something I am very intent on having done while I'm still young and able enough to bounce back from it. Anyone with any similar situations I would love to hear from as well. 

jtcarlto

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Re: fused knee reversal
« Reply #1 on: September 19, 2013, 07:27:19 AM »
That's terrible Alexandra.  I'm sorry that happened to you.  I was an idiot as a teen but luckily I made it out of there alive.

Anyways, I have not heard of knee fusion reversal (actually I have "heard" of it) but I have not heard like a full case history, you know?  Like comeback and all.

Doesn't mean you couldn't do it!  I think it would be possible theoretically.  They would have to removed the fused grafts and then probably replace your knee joint with a cadeaver knee joint--osteochondral allograft.  I can't imagine any other operation working.  It depends on how much of your actual knee joint is left???  A piece broke off from your femur--was it re-attatched?  I think you ought to go back the same surgeon, he sounded pretty decent, actually quite good relatively and ask for the operation that he didn't do at the time.  If he's not then I guess keep searching.

If you still have somewhat of an actual knee joint left, you could try to regenerate.  HGH could work, or stem cells, abrasion arthroplasty, PRP.  Would be difficult but is possible. 

I hope things work out for you Alexandra keep fighting and never give up!

Best of luck with your kneessss,
Jeff

Offline The KNEEguru

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Re: fused knee reversal
« Reply #2 on: September 19, 2013, 11:00:36 AM »
Yes, a reversal of a fusion is possible, but requires a very skilled surgeon and will also depend upon the condition of the bones and other structures of the knee. It would require a very competent surgeon.

About 20 years ago my ex-husband, Angus Strover, successfully reversed a fusion in a young woman by re-cutting the fused area and inserting a total knee replacement. He is retired and of course cannot help you. I remember that the patient was absolutely delighted and wrote him an epic and funny poem about how she used to manage taxis and aeroplanes and more intimate situations before the reversal procedure.

It is definitely worth your researching further.
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KNEEguru

jtcarlto

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Re: fused knee reversal
« Reply #3 on: September 20, 2013, 12:35:21 AM »
Here is a story on knee fusion reversal to knee replacement: http://abclocal.go.com/ktrk/story?section=news/health&id=7608915

Here is a paper on knee fusion reversal to osteochondral allograft: http://www.ncbi.nlm.nih.gov/pubmed/23014775

Offline Kaputt_Knee

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Re: fused knee reversal
« Reply #4 on: September 20, 2013, 08:40:17 AM »
Both those papers describe single and very exceptional cases jtcarlto. The first one reiterates what The KNEEguru said in her reply; it is a very rare situation and you need a surgeon who has the competency as well as the courage to be able to perform this extremely rare surgery. In the first paper they go to great lengths to emphasise that the risk of having to amputate instead is a very high one. The prosthesis replacement knee (TKR) is also an unusual one in the instant describe in the first paper, the implant rods are almost from hip to ankle.

Alexandra531
, you are only 19 or 20 I believe, if I have worked out the age and years correctly. You really need to talk to a specialist about this, so currently your search should be to find a surgeon who is prepared to listen and possible carry out the procedure, OR find someone who could do it for you. At your young age, the implantation of such long anchor rods for an artificial knee could be what would deter most surgeons. In your shoes, I would possibly contact the national association of orthopaedic surgeons in your country (the Royal College of Orthopaedic Surgeons in the UK and American Associations  of Orthopedic Surgeons in the USA) and ask there if there any surgeons who have carried out more than one of these types of operation. I would correspond with them first, NOT make an immediate appointment. If they are prepared to look at your case history would be the first step. This would not be an easy undertaking for any surgeon, but it is unusual enough to maybe interest some.

As far as I remember we have had two, possibly three people on here (none of whom post any more) who have had knee fusions (arthodesis) and two of them have subsequently had amputations and now use prosthetic limbs. I really don't think that other than The KNEEguru, who has the professional experience, that there is anyone else on here who has either the knowledge or the personal experience to advise one way or the other.

You really are between a rock and a very hard place Alexandra. I would not want to be in your shoes at all and do not even know how to do anything other than sympathise (how pathetic that sounds!). You really do need to find caring, experienced surgeons who will listen to you first and see you as a person rather than an unusual case they can write a paper about afterwards. I would say that that is your first task.

Just as an off the wall thought, maybe an email to the surgeon who saved Hermann Maier's leg (World Champion skier racer in Austria before and after his motorcycle accident) may actually be able to give you some names to write. I will try to find out his name for you and get back to you. He is still practising in the Regional Trauma Unit in Salzburg, I believe he is head of orthopaedics there but I'm not certain. I remember him saying that the leg was in such a bad way that if it had been any other person, he would have amputated. But he did not want to be known as the surgeon who amputated the leg of the biggest sporting hero in his country. ;) He still says that he was not sure if he was right and was so scared of the consequences of doing the wrong thing, he nearly did nothing! Sounds like a skilful but honest man to me.

Good Luck
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

jtcarlto

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Re: fused knee reversal
« Reply #5 on: September 20, 2013, 11:02:27 AM »
It doesn't matter if it's rare, push for the operation that gives you (her) the best quality of life.

I don't care if they hadn't performed an operation before, if it's goal was to get me my life back (and there where decent chances I would try it). 

Surgeon selection is of utmost importance.  I think she should go back to her original surgeon and see what he thinks.  The fact that he was considering fresh osteochondral allografts shows that he's not totally inept and the fact that she seems relatively pain-free is a kudo to him. 

She would have to consider that getting her "knee back" might come at a cost.  The fresh OCA plan could develop some arthritis (as in the paper) and the total knee could cause pain and complications. 

Offline caneguy

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Re: fused knee reversal
« Reply #6 on: March 22, 2021, 08:10:21 PM »
Dear Alexandra,

you wrote about your story some time back now.
How has life been going ever since?
It makes me sad, that your fused knee made you sad...
There are so many technical aids, you donīt need to abstain from anything.
You can ride a bike, you can drive a car (what you already may do?), you can dance.

Technically a fusion reversal is possible, in SOME cases, it is demanding and has a high rate of problems or failures. In very young people the lifetime of a TKR is limited, itīs forseeable to need more surgery in future, connected with all the risks. Nevertheless, some people are brave and take the risk. Some might even opt for amputation.

What has life given to you in the past times?
Would be cool to hear from you ;-)
Since 2005: wear a legbrace to keep the knee straight. I have suffered from a rare syndrome.
Around 2008: knee is now ankylosed, but not bony fusion yet
December 2009: definite, surgical knee fusion with a long nail

Offline Brandon123

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Re: fused knee reversal
« Reply #7 on: March 24, 2021, 03:21:33 PM »
Caneguy,

Just out of pure curiosity, how is blood circulation in the leg (and especially foot) and those things working when a knee is fused? I guess you can use ('pump') your calves normally? But the use of ham strings and quads must be quite limited, right?
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline caneguy

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Re: fused knee reversal
« Reply #8 on: March 25, 2021, 09:17:38 PM »
Yes, actually blood circulation may suffer somewhat when having a knee fusion.
Itīs best to rest the leg on a higher position when possible, like on a footstool or similar.
Some people tend to wear a compression stocking.
In theory there is a higher risk for thrombosis, but I donīt know any study that proves this.
The human body can compensate really a lot.
Since 2005: wear a legbrace to keep the knee straight. I have suffered from a rare syndrome.
Around 2008: knee is now ankylosed, but not bony fusion yet
December 2009: definite, surgical knee fusion with a long nail

Offline Brandon123

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Re: fused knee reversal
« Reply #9 on: March 27, 2021, 07:13:53 PM »
Thanks for the info, Caneguy! Seems you're doing pretty well overall despite your fusion. 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline caneguy

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Re: fused knee reversal
« Reply #10 on: April 02, 2021, 08:21:51 PM »
Thanks for the info, Caneguy! Seems you're doing pretty well overall despite your fusion.

Thatīs true, absolutely.
To be honest, "despite" is the wrong word here, "because" does it really say.
But thatīs a longer story ;-)
I wish I could give something of that to others with knee fusion...

Since 2005: wear a legbrace to keep the knee straight. I have suffered from a rare syndrome.
Around 2008: knee is now ankylosed, but not bony fusion yet
December 2009: definite, surgical knee fusion with a long nail

Offline Brandon123

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Re: fused knee reversal
« Reply #11 on: April 05, 2021, 04:33:40 PM »

To be honest, "despite" is the wrong word here, "because" does it really say.
But thatīs a longer story ;-)

Please share the story, if you want :)
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment