Total Knee Arthroplasty in Patients With Prior Ipsilateral Hip Fusion: A Surgical Technique

Abstract

Background: In patients with severe osteoarthritis of the knee with prior ipsilateral hip fusion who require total knee arthroplasty (TKA), a controversial issue is whether to first convert the hip fusion to a total hip arthroplasty (THA) or to perform TKA without reconstruction of the hip. Also, immobility of the ipsilateral, fused hip adds significant technical challenge because the usual positioning of the leg requires modification in order to gain access needed for the TKA. Technique: In such cases, we position the patient with the knee suspended, similar to how we perform knee arthroscopy. In our experience, the ipsilateral knee has significant deformity and is best addressed with a constrained, hinged TKA. Results: In 3 patients with severe knee osteoarthritis with prior ipsilateral hip fusion—a 72-year-old man and a 79-year-old woman with hip arthrodesis due to posttraumatic arthritis and an 81-year-old woman with hip arthrodesis due to congenital dislocation of the hip—rotating-hinge knee prostheses were implanted due to severe knee instability. All 3 patients had satisfactory results, without complications, after follow-up of 1 to 5 years. Conclusions: We obtained satisfactory results in the short and medium term without previously converting the hip arthrodesis to THA by positioning patients with the knee suspended, in a way similar to when knee arthroscopy is performed, and implanting rotating hinge TKAs due to severe preoperative knee instability.

Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review

“…Samborski et al [22] used multiple mattresses to raise the upper part of the body, the knee being positioned on the surgical table in the Mayo support that offered the possibility of controlled flexion. Ullan et al [23] positioned the limb in the Postoperative X-rays revealed adequate positioning and sizing of the prosthetic components and a restored alignment of the lower limb. Personalized rehabilitation was initiated 24 h after the surgery, with knee flexion being recovered at the edge of the bed, and knee extension in lateral decubitus; weight bearing was allowed on the 1st postoperative day, and the patient started walking with the aid of crutches.…”

“…Searching the PubMed and Google Scholar databases for "total knee arthroplasty" and "ipsilateral hip fusion/arthrodesis/ankylosis", we found 81 articles, out of which 12 included our criteria: patients with hip fusion/ankylosis/arthrodesis and ipsilateral knee osteoarthritis treated with a total knee replacement. These 12 studies followed and described the total knee arthroplasty in a total of 30 patients with ipsilateral hip fusion (Table 1) [1,3,9,[16][17][18][19][20][21][22][23][24]. Callaghan et al [1] was the first to mention the possibility of performing a TKA in a patient with same side hip fusion, without giving too many details about the respective patients or surgical technique.…”

“…Callaghan et al [1] was the first to mention the possibility of performing a TKA in a patient with same side hip fusion, without giving too many details about the respective patients or surgical technique. Out of these 12 articles, only 6 described the changes made to the surgical table during the arthroplasty [18,19,[21][22][23][24], and only 2 others mentioned the need for changes [3,17]. Goodman et al [18] positioned their patients as supine, with the table in Trendelenburg, broke the table at the level of the knee, causing the knee to hang outside; during the surgery, the table was lowered and elevated periodically.…”

“…Samborski et al [22] used multiple mattresses to raise the upper part of the body, the knee being positioned on the surgical table in the Mayo support that offered the possibility of controlled flexion. Ullan et al [23] positioned the limb in the arthroscopy support. Ashkenazi et al [24] positioned his patient similarly to Goodman et al [18]: table in Trendelenburg, broke the distal half of the table, the non-operating knee secured to the table break, and the operated knee bent at the level of the table break.…”

“…Other articles report satisfactory/good surgical outcomes without any complications in their respective follow-ups (Table 1) [18][19][20][21]23,24]. In 2017, de la Hera et al [20] published two cases; their first case was a 72-year-old patient with a fused hip at 5 • HF, 5 • HA, and 0 • HER, where they performed an ipsilateral TKA (PS NEX-GEN); the authors reported no complications after 11 years postop, with an improvement in KSS from 49 to 65 and increase from 38 to 68 in the WOMAC score.…”