Min Zeng1, Jie Xie1, Yihe Hu2. 1. Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China. 2. Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China. orthop_huyh@163.com.
Abstract
PURPOSE: Although total knee arthroplasty (TKA) entails diverse operative techniques and achieves varying results in patients with different knee pathologies, few studies have discussed TKA for Charcot joints. This study aimed to investigate the efficacy of TKA in patients with Charcot knees. METHODS: From 2009 to 2013, seven patients with eight Charcot knees were admitted to our institution. They were confirmed by pre-operative examination and subsequently underwent TKAs. The pre-operative clinical and imaging characteristics of their knees indicated that all were in the Charcot stages of reconstruction or coalescence. Rotating hinge prostheses were selected for three knees with severe bone deficiency and soft tissue imbalance, whereas long stem condylar-constrained prostheses were implanted in the remaining five cases. Autogenous bone grafts were used in three patients to repair residual defects after osteotomy. Clinical data, including Hospital for Special Surgery (HSS) knee scores, range of motion (ROM), complications, and radiographic data, were used to assess surgical efficacy. RESULTS: The mean HSS score increased from 45.8 ± 14.2 (24-60) points pre-operatively to 84.6 ± 4.8 (75-90) points at final follow-up (P < 0.01). ROM was 65° ± 25° (30°-100°) pre-operatively and 92° ± 11° (75°-110°) after arthroplasty (P < 0.05), indicating satisfactory outcomes. Radiographic findings, including assessment for prosthetic loosening and alignment changes, suggested favourable outcomes. CONCLUSIONS: TKA using constrained condylar or rotating hinge prostheses and autografts for massive bone defects is effective for Charcot knees in the reconstruction or coalescence stage. LEVEL OF EVIDENCE: IV.
PURPOSE: Although total knee arthroplasty (TKA) entails diverse operative techniques and achieves varying results in patients with different knee pathologies, few studies have discussed TKA for Charcot joints. This study aimed to investigate the efficacy of TKA in patients with Charcot knees. METHODS: From 2009 to 2013, seven patients with eight Charcot knees were admitted to our institution. They were confirmed by pre-operative examination and subsequently underwent TKAs. The pre-operative clinical and imaging characteristics of their knees indicated that all were in the Charcot stages of reconstruction or coalescence. Rotating hinge prostheses were selected for three knees with severe bone deficiency and soft tissue imbalance, whereas long stem condylar-constrained prostheses were implanted in the remaining five cases. Autogenous bone grafts were used in three patients to repair residual defects after osteotomy. Clinical data, including Hospital for Special Surgery (HSS) knee scores, range of motion (ROM), complications, and radiographic data, were used to assess surgical efficacy. RESULTS: The mean HSS score increased from 45.8 ± 14.2 (24-60) points pre-operatively to 84.6 ± 4.8 (75-90) points at final follow-up (P < 0.01). ROM was 65° ± 25° (30°-100°) pre-operatively and 92° ± 11° (75°-110°) after arthroplasty (P < 0.05), indicating satisfactory outcomes. Radiographic findings, including assessment for prosthetic loosening and alignment changes, suggested favourable outcomes. CONCLUSIONS: TKA using constrained condylar or rotating hinge prostheses and autografts for massive bone defects is effective for Charcot knees in the reconstruction or coalescence stage. LEVEL OF EVIDENCE: IV.
Authors: Ulrich Illgner; Jaap van Netten; Carolin Droste; Klaas Postema; Thomas Meiners; Hans H Wetz Journal: Diabetes Care Date: 2014-06 Impact factor: 19.112