Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases

Abe, Shuji; Kohyama, Kozo; Yokoyama, Hironobu; Matsuda, Shigeru; Terashima, Y.; Nakagawa, Natsuko; Saegusa, Yasuhiro; Fujioka, Hiroyuki

doi:10.1007/s10165-008-0079-3

Cited by 5 publications

(6 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, careful attention to soft tissue balance during TKA and late-onset instability at follow-up examination must be paid in RA patients with advanced forms of knee joint destruction. Cases of posterior subluxation in TKA-treated RA knees with flexion contracture were reported in the literature [ 12 ], but no knees showed dislocation in our series.…”

Section: Discussionmentioning

confidence: 75%

“…Post-TKA complications in severely damaged RA knees could include implant loosening [ 8 ], residual restrictions in range of motion (ROM) [ 9 ], instability [ 10 , 11 ], dislocation [ 12 ], peroneal palsy [ 11 ], infections [ 8 , 13 ], and periprosthetic fracture [ 10 , 13 ]. However, few studies have reported outcomes of TKA in severely degenerated RA knees [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mid-term clinical results of primary total knee arthroplasty using metal block augmentation and stem extension in patients with rheumatoid arthritis

Hamai

Miyahara

Esaki

et al. 2015

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundDespite recent advancements in rheumatoid arthritis (RA) pharmacotherapy, surgeons still encounter severely damaged knees. The purpose of the present study was to analyze the mid-term clinical results of total knee arthroplasty (TKA) with metal block augmentation and stem extension.MethodsA total of 26 knees in 21 patients who underwent primary TKA with metal block augmentation and stem extension were retrospectively reviewed. All patients with a mean age of 63 years had RA for a mean duration of 15 years. Functional and radiographic results as well as complications were evaluated at the mean follow-up period of 6 years after TKA. Eight knees were lost follow-up after the two-year evaluation.ResultsTibial bone defects with average depth of 19 mm were preoperatively recognized in all 26 knees. The postoperative joint line was reconstructed on average 11 mm above the fibular head using average thickness of 11 mm tibial inserts and 9 mm metal blocks with stem extension. Significant improvements (p < 0.05 for all comparisons) were observed postoperatively in maximum extension angle from −10° to −1°, range of motion from 101 ° to 115 °, and Knee Society Score (knee score/function score) from 35/18 to 90/64. Non-progressive radiolucent lines beneath the metal block and osteosclerotic changes around the medullary stem were found in 16 knees (62 %) and 14 knees (54 %), respectively. There was two failures (8 %): fragile supracondylar femur fractures and knee instability. No knees showed any radiographic implant loosening, dislocation, polyethylene insert breakage, peroneal palsy, or infection.ConclusionsPrimary TKA with metal block augmentation and stem extension could effectively restore function in RA patients with advanced forms of knee joint destruction, and be reliable and durable for a mean postoperative period of 6 years. Further study is needed to determine the long-term results of TKA using metal block augmentation and stem extension.

show abstract

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Mid-term clinical results of primary total knee arthroplasty using metal block augmentation and stem extension in patients with rheumatoid arthritis

Hamai

Miyahara

Esaki

et al. 2015

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…However, on the 20th postoperative day, the tibia dislocated posteriorly. This may have occurred because the extension angle was achieved within a very short period [ 6 ]. Another study indicated that severe flexion contracture greater than 90° could be treated with TKA, but that residual flexion contractures were observed postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few cases of the management of severe contractures have been reported. These previous studies showed poor results because residual flexion contractures were not corrected within a short period of time [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

A case report of successful treatment of 90° knee flexion contracture in a patient with adult-onset Still’s disease

Xiao

et al. 2016

BMC Surg

View full text Add to dashboard Cite

BackgroundSevere knee flexion contractures greater than 80° are rare and challenging to manage. Previous studies have demonstrated unsatisfactory clinical results after correcting these deformities because residual flexion contractures were not corrected within a short period of time. We herein report the case of a patient with adult-onset Still’s disease with 90° of bilateral knee flexion contracture, which was successfully corrected by total knee arthroplasty and serial casting over a period of five weeks.Case presentationA 47-year-old male was admitted to our orthopedic department for bilateral knee pain and a preoperative fixed flexion contracture of 90°. A diagnosis of adult-onset Still’s disease was made based on the patient’s medical history of a high spiking fever, salmon-colored rash and bilateral knee and wrist pain. Bilateral total knee arthroplasty was carried out to address these deformities, but residual flexion contracture was present. Subsequently, serial casting was used to achieve full extension at four weeks after surgery. Excellent function and patient satisfaction were observed at two years of follow-up.ConclusionThe new protocol of total knee arthroplasty with subsequent serial casting seems to be an efficient solution for knee flexion contractures greater than 80°. This report adds to the very small number of reported cases of adult-onset Still’s disease with severe knee flexion contractures and describes a patient who was successfully treated with a new protocol.

show abstract

“…For RA patients, bone cuts have to be performed according to the anatomy and implant design and appropriate ligament balancing is required. However, it is potentially a poor strategy, as more bony cuts are needed to get the knee straight in the operation of RA patients with severe flexion contracture, which creates more problems with respect to instability thereby causing pain and dysfunction [ 8 , 9 ]. However, incomplete intraoperative correction of severe flexion deformity would lead to more residual flexion contracture postoperatively [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture

2013

View full text Add to dashboard Cite

BackgroundThis study aims to explore the technique of soft tissue balance and joint tension maintenance in total knee arthroplasty (TKA) for the rheumatoid arthritis (RA) patients with flexion contracture of the knee.MethodsThis retrospective study reviewed flexion contracture deformity of RA patients who underwent primary TKA and ligament and soft tissue balancing. Based on the flexion contracture deformity, the remaining 76 patients available for analysis were divided into two groups, i.e., severe flexion group (SF) and moderate flexion group (MF).ResultsThere were no intraoperative complications in this study. All patients had improved Knee Society Rating System scores and range of motion. The flexion contracture was completely corrected in MF and SF patients. There were no cases of patellar dislocation, but three cases had mild mediolateral instability in severe flexion group. Four knees (two knees in SF versus two knees in MF) had transient peroneal nerve palsy but recovered after conservative therapy.ConclusionsTKA can be performed successfully in the RA knees with severe flexion contracture. It is very important in TKA to maintain the joint stability in the condition of severe flexion contracture deformity of the RA knee.

show abstract

Total knee arthroplasty for rheumatoid knee with bilateral, severe flexion contracture: report of three cases

Cited by 5 publications

References 12 publications

Mid-term clinical results of primary total knee arthroplasty using metal block augmentation and stem extension in patients with rheumatoid arthritis

Mid-term clinical results of primary total knee arthroplasty using metal block augmentation and stem extension in patients with rheumatoid arthritis

A case report of successful treatment of 90° knee flexion contracture in a patient with adult-onset Still’s disease

Total knee arthroplasty treatment of rheumatoid arthritis with severe versus moderate flexion contracture

Contact Info

Product

Resources

About