Case of consecutive excision of both knee-joints for disease, terminating in recovery / by James Barron.

  • Barron, James, 1954-
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Case of consecutive excision of both knee-joints for disease, terminating in recovery / by James Barron. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    by any secondary symptoms. Married fifteen years; no family living, but his wife has borne him four children, the first of whom died a few hours after birth, and the others at six, eight, and twelve months respectively, as he says, of inflammation of the lungs. His wife has had no miscarriages. Family history is entirely negative; no rheumatism; no joint affection; no chorea; and no consumption. For about three weeks after admission, iodine was painted on both knees, and a blister was applied, but without any apparent advantage. After much consideration, and consultation with my colleagues, I decided to perform excision of the joints as the most likely means of relieving my patient from his unfortunate position, and procuring for him, as I hoped, good and useful limbs. He and his family were duly informed of all the possible evil consequences that might result from a failure in the operation, but he quickly decided in favour of my recommendation, only desiring me, if possible, to save his leg. First Operation.—On June 20th, 1877, with the kind help of my colleagues, the patient being first placed under the influence of chloroform, I proceeded to excise the right knee-joint. The operation was performed in the usual way, by a curved incision, and under complete antiseptic precautions. On opening the joint, the synovial membrane was found in an advanced stage of gela- tinous degeneration; the cartilage on the inner condyle of the femur was ulcerated, as was that on the corresponding surface of the tibia, and there was partial dislocation of the tibia backwards. Before closing the wound, as much as possible of the diseased synovial membrane was removed. A drainage tube was inserted along the floor of the wound from side to side, and the limb put up straight on an ordinary Macintyre splint. There was nothing particular to record in the progress of the case; the drainage tube was removed on the 29th of August, the seventieth day of treatment, and on September the 15 th, the eighty-seventh day, bony union was complete, and the splint was discarded. During this time, the swelling and heat of the left knee had subsided, and there was partial bony ankylosis. Second Operation.—The first operation having been so successful, I was encouraged to proceed with the excision of the left knee; and accordingly, on October the 10th, I performed the second operation. This was done, as before, under complete antiseptic precautions. On opening the joint, there was found bony ankylosis between the tibia and posterior portion of the articular surface of the femur, the tibia being dislocated backwards. In the first operation, adaptation of the bones was easily accom- plished, but in the second, perfect adjustment was not effected until a second piece was removed from the tibia, and two or three