Case of excision of the knee-joint / [William Keith].

  • Keith, William, 1802 or 1803-1871.
Date:
[1854]
Catalogue details

Licence: Public Domain Mark

Credit: Case of excision of the knee-joint / [William Keith]. Source: Wellcome Collection.

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    ing the wound permanently, hut it were hopeless to make any such attempt wuth amputation ; and it is important, on the patient’s account, to keep him as short a time as possible on an operation table. The after condition of John Hay proved the entire absence of shock to the system ; no fever followed ; his appetite was unimpaired, and any suppuration that occurred was trifling in the extreme. As to the nature and period of his confinement after the operation, he was able on the sixteenth day to sit up in bed ; on the sixty-second day he was allowed to dress and go about on crutches ; bearing part of his weight on the right foot; on the eighty-second day he was so firm on his feet, and so sound about the joint, as to be consideied no longer un¬ der surgical care—a period which any surgeon would gladly accept as a favourable average, if obtainable after amputation of the thigh in a scro¬ fulous subject The important question has been asked,—Should the hones he united by anchylosis after excision of the knee joint, or should any attempt be made to form a moveable or artificial joint ? In confirmed scrofulous disease of the knee joint, anchylosis, if ac-^ oomplished with the limb nearly straight, is very justly considered a fa¬ vourable termination to the case—the very fixing of the joint affording a security against the recurrence of like disease in the same joint. Consi¬ dering, then, the kind of constitution that is so likely to exist in the subject requiring excision of the knee, the risk would be great indeed that diseased action would immediately commence were the denuded head of the tibia required to form a socket in which the end of the shaft of the femur was to roll and rotate, and that also while it had to support the superincum¬ bent weight of the whole body in locomotion. There cannot be a doubt, therefore, that anchylosis must he secured in every instance to ensure safety to the limb, and solid comfort to the patient. The femur and tibia being both sawn across, callus readily unites them, and the patella, intentionally denuded of cartilage, occupies a most important, as well as favourable position, for forming a strong con¬ necting link or band between them, whether the union of the three be by perfect osseous intermixture, or partially by fibrous tissuej the limb straight and strong from being stiff, will safely encounter the fatigues of travel, not more, but now less, subject to disease than the opposite limb. In the case just recorded, the bony union is complete, proving that such is practicable —it is comfortable to the patient and useful. It needs no prophet to fore¬ tell, that as sure as it is the rule of practice to insure mobility in the elbow after excision of that joint, so sure will the rule be to secure immobility after excision of the knee joint. May 22d.—John Hay presented himself at the Hospital, walking with the aid of a support in one hand—the knee stiff, and the limb useful. 6. RENNIE^ P li INTER, Broad STREET, ABBRDKElf. t