Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy

Abstract

Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.

Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review

“…Rotating hinge prosthesis could provide better three‐dimensional freedom, and has been more frequently chosen for TKA to treat Charcot knee in the last 10 years (Figure 2 ). 20 , 21 Recently, more studies 5 , 6 , 9 , 10 , 22 , 23 , 24 , 25 , 26 , 27 , 28 reported the use of condylar constrained prostheses and rotating hinge prostheses with satisfied results for TKA in Charcot knee.…”

“… 2 , 3 Neuroarthropathy of the knee, also known as Charcot knee, is a rare joint disease, but is gaining concern with increasing worldwide incidence of diabetes in recent decades. 4 , 5 , 6 Before the turn of the century, the main interventions for Charcot knee were conservative treatments or joint fusion surgery. Joint arthroplasty was once contraindicated for Charcot knee due to the high incidence of serious complications.…”

“…Caused by sensory, motor, or autonomic neuropathy, this condition often results in severe joint deformity and dysfunction 2,3 . Neuroarthropathy of the knee, also known as Charcot knee, is a rare joint disease, but is gaining concern with increasing worldwide incidence of diabetes in recent decades 4–6 . Before the turn of the century, the main interventions for Charcot knee were conservative treatments or joint fusion surgery.…”