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When arthroplasty is impracticable, and a movable joint is desired for example at the elbow a considerable amount of bone, and it may be also of periosteum and capsular ligament, is resected to allow of the formation of a false joint.
The joints of the lower extremity are especially apt to suffer; the child is seriously ill, is delirious at night, develops bed-sores over the sacrum and, it may happen that, not being expected to recover, the legs are allowed to assume contracture deformities with ankylosis or dislocation at the hip and flexion ankylosis at the knees; should the child survive, the degree of crippling may be pitiable in the extreme; prolonged orthopædic treatment and a series of operations arthroplasty, osteotomies, and resections may be required to restore even a limited capacity of locomotion.
Arthroplasty is most successful in ankylosis following upon injury; when the ankylosis results from some infective condition such as tuberculosis or gonorrhœa, it is liable to result in failure either because of a fresh outbreak of the infection or because the ankylosis recurs.
Forcible breaking down of adhesions under anæsthesia is not recommended, as it is followed by great suffering and the adhesions re-form. Operation for ankylosis arthroplasty should not be undertaken, as the ankylosis recurs. Tuberculous disease of joints results from bacillary infection through the arteries.
Arthrolysis, which consists in opening the joint and dividing the fibrous adhesions, is almost inevitably followed by their reunion. Arthroplasty. Murphy of Chicago devised this operation for restoring movement to an ankylosed joint.
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