On excision of the knee-joint / by R.J. Mackenzie.

  • Mackenzie, Richard James, 1821-1854.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On excision of the knee-joint / by R.J. Mackenzie. 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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    tm'bcil. I'lie cartilage, however, wliicli remained on its surface was removed by the gouge, as well as the rough surface of bare bone around its articular margin. The amount of bleeding was veiy tritiing: one of the articular branches and several small vessels wei*e secured by ligature, and the wouiul was dressed and the limb sup- ported ns I have already described in my former case. (The interior of the joint presented the usual ajtpearances accompanying advanced strumous disease of the synovial membrane, suppuration of the joint, universal thickening and degeneration of the membrane, and ulcera- tion of the margins of the cartilage in nearly their entire extent. Great part of the cartilage covering the articular end of the bone was as yet unaltered. Three-fourths of an inch of the tibia, and fully an inch and a half of the femur, were removed.) With regard to the progress of this case since the performance of the operation, I need only say that the patient has suffered as little local and con- stitutional disturbance as usually follows excision of the elbow-joint, and certainly very much less than usually follows amputation of the thigh. He has been almost entirely free from pain, and has sle])t and eaten well, whilst his general appearance has been such that no one, who was unaware of the operation which had been performed, would, on seeing him, have imagined that he had undergone an operation which was dangerous to life. Nearly a half of the wound is already healed, and the remainder is covered by healthy granula- tions. The discharge, which has never been great, is already diminishing in quantity. There has not been the slightest tendency to displacement of the bones from the straight position,—a circum- stance which I attribute, in a considerable measure, to the ])atella and its attachments having been left undisturbed. Little more than a fortnight has elapsed since the operation was performed, and I am, therefore, unwilling to say more of the case at present than that it promises, as far as it has gone, a most favourable result. Whilst writing this notice of the above cases, I have received, by the kindness of Mr Page of Carlisle, an account of another case, in Avhich that gentleman performed the operation about a year ago on a lad of seventeen years of age. The o))eration was performed, June 7, 1852. The patella, and two and a half inches of the femur and tibia, were removed. At no time after the operation was thm’e any important amount of constitutional disturbance. l\Ir Page gives the following account of his present condition :—“ He is now able to walk quite firmly, and without a stick, for a short distance, and is daily gaining greater control over the limb. He wears a shoe, the sole of which is about three inches thickened, that being the amount of shortening. The thigh and leg bones are firmly united, forming a firm and perfectly straight limb. The size in the situation of the excised joint is about that of the opposite knee.” The onl}'^ remaining case in which 1 am aware of the operation having been performed within the last few years, is one in wliich Dr ITStewar^j^Belfa^^va^h^perator