Total knee arthroplasty in osteogenesis imperfecta

Abstract

Osteogenesis imperfecta is a genetic disease resulting in abnormal collagen formation, with multiple clinical manifestations. Advancements in medical and surgical treatments have prolonged the life expectancy of these patients in recent decades. As a result, orthopedic surgeons are likely to be faced with the challenge of performing arthroplasty in these patients on a more frequent basis. Here, we describe a patient with osteogenesis imperfecta and subsequent severe osteoarthritis prompting primary total knee arthroplasty. This rare case presents an opportunity to explore special considerations unique to this patient population, including comorbid bone defects, the need for using extramedullary guides, careful alignment of prostheses to accommodate abnormalities in limb axes, and equipment utilization.

Total knee replacement in Osteogenesis Imperfecta: a case report and review of the literature

“…[ 5 ] 2 46, M Osteoarthritis Cruciate-retaining, femur and tibia osteotomies (femur retrograde intramedullary nail and flexible titanium intramedullary nails) 37, M Bilateral Osteoarthritis Right : Posterior-stabilised, femur and tibia osteotomies (flexible titanium intramedullary nails) Left: Posterior-stabilised, femur and tibia osteotomies (flexible titanium intramedullary nails and dynamic compression plates) Left Conversion : tibia intraoperative periprosthetic fracture, tibia component revised cemented tibia 80 mm stem and 10 mm augment during the primary procedure Brand et al . [ 7 ] 1 69, F Osteoarthritis Posterior-stabilised Sanz-Ruiz et al . [ 1 ] 1 65, F Hip femoral stem perforated through trochlea Total femur replacement, hinged prosthesis and stemmed tibia …”

“…This necessitates meticulous pre-operative planning in the form of templating using sizing markers on the planning radiographs to ensure the specific implant size is available for the patient. In the absence of such implants, patient-specific implants and cutting guides should be considered for outlier cases [ 7 ].…”

“…The milder soft tissue imbalances can be managed with soft tissue release intraoperatively. However, constrained implants should be considered for the deformities of more than 20 degrees [ 7 , 8 ]. In our case, we performed a total knee replacement with a hinged prosthesis due to the patient’s incompetent medial collateral ligament.…”

“…Long bone bowing and the resultant deformities pose an alignment challenge and the mechanical axis and angular deformities must be evaluated preoperatively [ 7 ]. The femur presents with 46–86% anterolateral bowing and associated 27–86% anterior bowing of the tibia [ 4 ].…”

“…[ 5 ], had a single case of tibia non-union 11.5 months after the procedure, which was managed with open reduction and internal fixation and augmented with iliac crest autograft. The use of intra-medullary referencing in patients with deformity or a narrow canal with deformity may lead to iatrogenic fractures and recommendations have been made for extramedullary referencing techniques, patient-specific cutting blocks or navigation assistance [ 6 , 7 ].…”