Volume 1

A manual of operative surgery / by Sir Frederick Treves.

  • Sir Frederick Treves, 1st Baronet
Date:
1903
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: A manual of operative surgery / by Sir Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    701/808 (page 681)
    a remarkable enthusiasm, and tlie recorded cases published during the period named may be counted by hundreds. Of late years a reaction has taken place, and excision of the knee has now a place among operations which are but rarely per- formed, or which are extensively practised but by very few. At the present time excision of the knee is but rarely carried out in private practice, and in hospital wards the pro- cedure would appear to be becoming rarer and rarer. The result aimed at is the production of a rigid anchylosis in the extended position, and the attempts to obtain a mobile joint have met with very few successes and a very numerous list of lamentable failures. The subperiosteal method can hardly be carried out in this articulation, and may be considered as mapplicable. The after-treatment is, on the whole, of more importance than the operation itself. Displacement of the bones—and notably a gliding of the femur forwards—is very apt to occur. In young subjects gi'eat care must be taken not to en- croach upon the lower epiphysis of the ft3mur, which is the most important epiphysis of the lower extremity. An admirable criticism of the operation is provided by Mr. Howard ]\Iarsh in his manual on Diseases of the Joints. Anatomical Points.—This articulation is the largest in the body, and owes its great strength to the powerful ligaments which unite the two component bones, and to the muscles and fascine that surround it. It derives no strength from the shape of the articular surfaces, since they are merely placed in contact with one another. The axis of the limb is abruptly altered at the knee-joint, the femur inclining iuAvards from the pelvis, and the tibia being vertical. The lateral ligaments of the joint are comparatively feeble, the posterior ligament is substantial, and the anterior part of the capsule is formed of a firm aponeurotic expansion. The most powerful and most important ligaments of the joint are the crucial. The synovial membrane of the Imee-joint extends upwards as a large cul-de-sac above the patella and beneath the extensor tendon (Fig. 203). This cul-de-sac reaches a point an inch or more above the upper margin of the trochlear surface