Total joint replacement of the hip and knee in patients with arthrogryposis multiplex congenita: a report of six joints

Abstract

Introduction Arthrogryposis multiplex congenita (AMC) is a rare congenital condition that leads to severe joint contractures and deformities. As painful joint dysplasia and degeneration might develop over time, total joint replacement (TJR) can be a potential treatment option for these patients. The aim of this study is to investigate functional results, implant survivorship and potential complications in patients with AMC who undergo hip or knee arthroplasty. Materials and methods We retrospectively identified six TJR in three patients at a single centre performed between 2006 and 2019. The median patient age at surgery was 23 years and the median follow-up period was 69 (IQR 55–99) months. We analysed surgical technique, implant survivorship and complications as well as functional outcome determined by pain reported on the Numerical Rating Scale (NRS), patient-reported outcome scores [Oxford Hip Score (OHS), Harris Hip score (HHS), Oxford Knee Score (OKS)], range of motion and ambulatory status. Depending on data distribution means with ranges and median with interquartile range were compared with the Wilcoxon signed rank test or Student’s t test. The level of significance was defined at < 0.05. Results In hips, the mean range of motion in flexion/extension (52° vs. 85°, p = 0.014) and in rotation (28° vs. 68°, p = 0.02) as well as mean pain score on the NRS (8.5 vs. 0, p = 0.001), OHS (9 vs. 26, p = 0.031) and HHS (17 vs. 52, p = 0.007) significantly improved. In knees, mean range of motion (55° vs. 93°, p = 0.403), mean pain score on the NRS (0 vs. 7) and the OKS (2 vs. 21) also improved. While the ambulatory status did not change, the patients who were wheelchair dependent reported less problems with transfers to a bed or chair and the patient who ambulated reported an improved walking distance. One total knee arthroplasty (TKA) underwent revision for an acute, late infection 155 months following the initial surgery. Conclusions TJR is a safe procedure in patients with AMC that effectively improves function and reduces pain irrespective of preoperative ambulatory status.

Effects of different doses of dexmedetomidine combined with sufentanil in intravenous controlled analgesia after Salter osteotomy in children

“…Currently, clinics have used many kinds of postoperative analgesics, which are mainly divided into two categories: opioids and non-opioids ( 13 – 15 ). Common opioids include morphine and fentanyl, whereas non-opioid drugs include non-steroidal anti-inflammatory drugs and alpha-2 adrenoceptor agonists ( 16 – 19 ). Opioids are the most potent analgesic drugs discovered thus far, and their analgesic effects increase with the dose.…”

Dexmedetomidine combined with sufentanil in intravenous controlled analgesia after hip arthrotomy in children

“…Each step may be a potential target for pain therapy. Individuals' perception of postoperative pain varies greatly, which is in uenced by surgical method, gender, age, personality, social experience, and so on [15] . Its pain reaction may occur at all levels of the central nervous system, and its impact on the body almost involves all systems of the body.…”

Revision Total Hip Arthroplasty using a Direct Anterior Approach in a Patient with Arthrogryposis Multiplex Congenita: A Case Report

“…Theil et al. reported a series of 2 patients who underwent unilateral and 1 patient who underwent staged bilateral primary THA via a lateral approach (Theil et al 2020).…”