The central-graft fusion operation, originally described by Hatt, in our experience has proved its value and has been most successful in the treatment of tuberculous knees and ankles, and reasonably successful in the treatment of tuberculous elbows.
In children, especially, the operation is of supreme value because it offers a high percentage of successful joint fusions without causing cessation of bone growth. In the series of cases just reviewed, solid bone fusion by this operation was obtained in all of the fifteen children with tuberculosis of time knee.
In the fusion of tuberculous knee joints in children it is of extreme importance to avoid allowing the patella to become attachmed to the femur at the anterior epiphyseal line; in our series of cases, this produced local cessation of growth with resulting marked genu recurvatum and shortening.
In adults, the single-central-graft fusion operation for tuberculosis of the knee was successful in all of the nine patients operated on, although one patient required a second operation. In the ten adults who underwent the more conservative dual-central-graft operation for tuberculous knees, successful fusions occurred in eight patients and failure occurred in two.
In the treatment of tuberculosis of the ankle, the central-graft fusion operation was performed in four children and five adults. Fusion was obtained in all of the patients, and we have had no failures. Also, it is of interest to know that this success was obtained without opening up of the diseased joints or erasion of the joint cartilages.
In tuberculosis of the elbow, the operation was not quite so successful as it has proved to be in the cases of disease of the knee and ankle. Six patients with tuberculosis of the elbow were operated on, and although fusion was obtained in five of them with the use of the central graft, a second operation was required in two of the patients. The one failure remained a non-union, and the patient declined another operative procedure because he was content with the result that he had.