Total knee replacement in triple deformity with posterior subluxation of the knee joint

Abstract

Total knee replacement a b s t r a c tDislocation or subluxation following total knee arthroplasty has been extensively reported, but vice versa that is total knee replacement for subluxed or dislocated knee has not been published. Triple deformity of knee that is flexion, external rotation, valgus at knee associated with posterior subluxation of tibia occurs in rheumatoid arthritis, advanced tubercular arthritis and neglected posttraumatic residual dislocated knee. A 50 year old female with seropositive rheumatoid arthritis had the above disabling deformity in left lower limb and varus with medial tibial thrust in the other. Bilateral total knee arthroplasty was planned. Conservative method of reduction of left knee posterior subluxation preoperatively by 90-90 skeletal traction failed; hence patient was subjected to a staged bilateral total knee replacement using an innovative technique. The most difficult and determining initial surgical step of knee replacement in such dislocated/subluxed knee is reduction of posterior subluxation and gaining flexion at knee, as only after gaining flexion and reducing dislocated tibia, will we be able to do knee arthroplasty in triple deformity of knee.These knees are grossly unstable as most of the capsule-ligamentous structures are attritioned/non-existent. So, a fine balance of bone cuts and soft-tissue release needs to be done in a sequential manner to fine tune valgus and posterior subluxation correction without jeoparadising neurovascular structures. After 3 years of knee arthroplasty the patient has painless, stable knee with good range of motion and is able to do all her activities, of living in a hilly terrain.

Concurrent femoral and tibial osteotomies versus soft tissue balance in total knee arthroplasty: A technical case report

“…There are quite a few case reports pertaining to knee arthroplasty in cases of complex knee deformities, and none of these describe secondary post-osteomyelitis arthritis. [17][18][19] Osteoarticular infections (OAI) are frequent in pediatrics, with an annual incidence in developed countries between 10 and 25 per 100,000 children. 20 If not treated, severe bone damages can result in residual complex deformities, and a reconstruction surgery is a challenge for every surgeon.…”