Total Knee Arthroplasty with Prior Ipsilateral Hip Arthrodesis

Abstract

Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature. Traditionally, TKA is performed supine, with the aid of knee-positioning devices allowing for hip flexion and range of motion of the knee to facilitate ease of surgical intervention. However, TKA using traditional positioning would not be possible in the presence of ipsilateral hip arthrodesis preventing hip motion. This case report describes a TKA performed for a 72-year-old woman with end-stage osteoarthritis of the right knee, ipsilateral hip arthrodesis, and leg-length discrepancy as the sequelae of slipped capital femoral epiphysis. We describe novel surgical positioning to be used to facilitate TKA in the absence of ipsilateral hip motion with bed modifications and the use of an extremity positioning device.

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

“…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.…”

“…Tang et al [21] suspended the knee over the distal half of the broken table with the contralateral limb in the lithotomy position. 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.…”

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

“…Disarthrodesis has a high complication rate due to the biomechanical alterations of the hip, the arthrodesis itself, and the complexity of the surgical technique. Therefore, in patients with functional and well-positioned hip arthrodesis (15° to 30° of flexion, 5° to 10° of adduction, and 0° to 10° of external rotation), hip arthrodesis conversion to THA is not always necessary before performing TKA [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

“…Alternatively, the patient can be positioned supine at the bottom of the table, allowing the knee to bend from the end of the operating table [15]. Another approach proposes elevation of the patient's upper body and contralateral leg and using a mobile leg positioner to facilitate exposure [11].…”