Total knee arthroplasty after osseous ankylosis of the knee joint

Yıl 2015, Cilt: 49 Sayı: 5, 503 - , 24.09.2015

Emrah Kovalak , Ata Can , Nese Stegemann Ayse Erdogan Fahri Erdogan

Öz

Objective: A knee fusion is associated with considerable restrictions, including the inability to sit properly, use public transportation, and climb stairs. The purpose of this study is to report and discuss our cases of spontaneous ankylosed knees which were taken down and underwent total knee arthroplasty (TKA).
Methods: Six patients who experienced spontaneous ankylosis of the knee undergoing conversion to TKA between 2003–2012 were enrolled retrospectively in this study. The etiology was childhood pyogenic arthritis in 2 patients, intraarticular fractures in 2, gunshot in 1, and juvenile rheumatoid arthritis in 1. The clinical data were recorded with the use of the Hospital for Special Surgery (HSS) knee rating system, Western Ontario and McMaster Questionnaire (WOMAC), and Visual Analog Scale (VAS), preoperatively and postoperatively at final follow-up.
Results: The average follow-up time was 86 months (range: 22–126 months). At the final follow-up, the average range of active flexion was 85° (range: 75–95°). Postoperative average HSS knee rating system was improved from 19.5 (range: 18–22) to 57.49 (range: 46–80), WOMAC was improved from 39.75 (range: 36.4–43) to 62.41 (range: 50.8–74.5). VAS was improved from 9.5 (range: 7–9) to 2.8 (range: 2–4). A pyogenic infection developed in 2 patients; 1 was managed by debridement, and 1 was managed by arthrodesis 2 years later.
Conclusion: The ability to walk and sit in a normal fashion is of great importance for patients. With good preoperative planning and careful handling, gratifying results are possible with TKA.
 

 

Anahtar Kelimeler

Knee ankylosis; knee arthrodesis; knee fusion; total knee arthroplasty.

Diz ekleminde gelişen ankiloz sonrası total diz artroplastisi uygulaması

Öz

Özet:

Amaç:

Ankiloze olan diz eklemi uygun şekilde oturma, merdiven ve toplu taşımanın kullanımı dahil olmak üzere belirgin kısıtlılıklara yol açar. Bu çalışma ile amacımız, ankiloz gelişmiş olan ve total diz artroplastisi uygulanmış olgularımızın sonuçları bildirmek ve tartışmaktır.

Hastalar ve metot:

Bu çalışmada 2003 ile 2012 yılları arasında diz ekleminde ankiloz nedeni ile total diz artroplastisi uygulanmış olan 6 hasta geriye dönük olarak değerlendirildi. Ankiloze dizlerin etiyolojilerine baktığımızda, 2 hastada çocukluk döneminde geçirilmiş piyojenik artrit, 2 hastada eklem içi kırık, bir hastada ateşli silah yaralanması ve 1 hastada ise romatoid artrit bulunmakta idi. Klinik değerlendirme, ameliyat öncesi ve ameliyat sonrası son takipte ‘’The Hospital for Special Surgery’’ (HSS) diz derecelendirme sistemi, ‘’Western Ontario Mac Master Anketi’’ (WOMAC) ve görsel analog skala (VAS) kullanılarak yapıldı.

Bulgular:

Ortalama takip süresi 86 ay idi (22-126). Son kontrolde ortalama hareket açıklığı 85° (75°-95°)idi. İki hastada 10°ekstansiyonda kısıtlılık var idi. Ameliyat sonrasında ortalama HSS skorlarının 19.5 (18-22) tan 57.49’a (46-80), WOMAC skorlarının 39.75’ten (36.4-43) 62.41’e (50.8-74.5) yükseldiği görüldü. VAS skorları ise 9.5’ten (7-9) 2.8’e (2-4) geriledi. 2 hastada enfeksiyon gelişti. Bir hastada debridman ile tedavi sağlanırken, diğer hastada 2 yıl sonra artrodez yapıldı.

Çıkarımlar:

Tüm risk ve komplikasyonlarına rağmen yürüme ve normal bir şekilde oturabilmek hastalar için çok önemlidir. İyi bir cerrahi öncesi planlama ve dikkatli bir cerrahi ile iyi sonuçlar alınması mümkündür.

Anahtar kelimeler:

Diz replasman artroplastisi, diz ankilozu, diz artrodezi

Anahtar Kelimeler

-

Kaynakça

• Kim YH, Kim JS, Cho SH. Total knee arthroplasty after spontaneous osseous ankylosis and takedown of formal knee fusion. J Arthroplasty 2000;15:453–60.
• Lien SB, Lee CH, Shen HC, Wu SS, Huang GS. Con- version of formal knee fusion to to-tal knee arthroplasty. J Med Sci 2003;23:347–50
• Henkel TR, Boldt JG, Drobny TK, Munzinger UK. Total knee arthroplasty after formal knee fusion using uncon- strained and semiconstrained components: a report of 7 cases. J Arthroplasty 2001;16:768–76.
• Cermak K, Baillon B, Tsepelides D, Vancabeke M. Total knee arthroplasty after formal knee fusion in a patient with Ehler Danlos syndrome. Acta Orthop Belg 2003;79:347– 50.
• Kim YH, Oh SH, Kim JS. Conversion of a fused knee with use of a posterior stabilized total knee prosthesis. J Bone Joint Surg Am 2003;85-A:1047–50.
• Mullen JO. Range of motion following total knee ar- throplasty in ankylosed joints. Clin Orthop Relat Res 1983;179:200–3.
• Schurman JR 2nd, Wilde AH. Total knee replacement after spontaneous osseous ankylosis. A report of three cases. J Bone Joint Surg Am 1990;72:455–9.
• Cameron HU, Hu C. Results of total knee arthroplasty following takedown of formal knee fusion. J Arthroplasty 1996;11:732–7.
• Bradley GW, Freeman MA, Albrektsson BE. Total pros- thetic replacement of ankylosed knees. J Arthroplasty 1987;2:179–83.
• Aglietti P, Windsor RE, Buzzi R, Insall JN. Arthroplasty for the stiff or ankylosed knee. J Arthroplasty 1989;4:1–5.
• Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–4.
• Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beyn- non BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998;28:88–96.
• Young CF, Bourne RB, Rorabeck CH. Tibial tubercle os- teotomy in total knee arthroplasty surgery. J Arthroplasty 2008;23:371–5.
• Clemens D, Lereim P, Holm I, Reikerås O. Conversion of knee fusion to total arthroplasty: complications in 8 pa- tients. Acta Orthop 2005;76:370–4.
• Naranja RJ Jr, Lotke PA, Pagnano MW, Hanssen AD. To- tal knee arthroplasty in a previously ankylosed or arthrod- esed knee. Clin Orthop Relat Res 1996;331:234–7.
• Kim YH, Cho SH, Kim JS. Total knee arthroplasty in bony ankylosis in gross flexion. J Bone Joint Surg Br 1999;81:296–300.
• Holden DL, Jackson DW. Considerations in total knee arthroplasty following previous knee fusion. Clin Orthop Relat Res 1988;227:223–8.
• Cho SH, Jeong ST, Park HB, Hwang SC, Kim DH. Two- stage conversion of fused knee to total knee arthroplasty. J Arthroplasty 2008;23:476–9.
• Mahomed N, McKee N, Solomon P, Lahoda L, Gross AE. Soft-tissue expansion before total knee arthroplasty in ar- throdesed joints. A report of two cases. J Bone Joint Surg Br 1994;76:88–90.