Conversion from knee arthrodesis to arthroplasty: systematic review

Abstract

Purpose Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA and assess clinical outcome, complication rate, surgical technique and overall patient-related outcome measures. Methods PubMed, Embase, Web of Science, Cochrane, CENTRAL, CINAHL, Academic Search Premier, ScienceDirect and searching by hand for papers on conversion of AD of the knee to TKA. Two reviewers independently reviewed all titles and abstracts, and extracted the available data. Study eligibility criteria were: conversion of knee AD to TKA, five cases or more and non-oncology patients. Data consisted of study characteristics, patient demographics, clinical outcome and complications. Additionally, details on surgical technique were reviewed. Results Of the 866 unique references identified, six papers were included for further analyses, comprising a total of 123 knees with conversion of AD of the knee to TKA. Mean gain of knee flexion was 80 degrees and the mean HSS score improved with 20 points. A complicated postoperative course was found in 65 % of all cases. The most frequent complication was skin necrosis (25 %), followed by arthrofibrosis (13 %), infection (11 %) and revision (11 %). Major complications such as refusion, amputation and death occurred in less than 5 % of all cases. Discussion The majority of the papers consisted of small case series of moderate methodological quality, resulting in 123 included knees. Further series are necessary to draw definitive conclusions. Conclusions This is the first systematic review and metaanalysis on conversion of a knee arthrodesis to TKA. Good clinical results can be expected after conversion, albeit at a high risk of postoperative complications.

Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection

“…Nevertheless, most patients were satisfied with the procedure. Kernkamp et al [11] reported in their analysis of 123 converted TKA a mean gain of flexion to be 80 and an improvement of Hospital for Special Surgery score by 20 points. However, they reported complications including skin necrosis (25%), infection (11%), revision (11%), and refusion of the knee (4.9%).…”

“…In addition, realistic patient expectations with regard to the functional outcome along with the willingness and motivation to continuously participate in the postoperative follow-up care are needed for the success of the procedure [1,9,10]. A recent meta-analysis showed good clinical results but a high complication rate of up to 65% [11]. The importance of a thorough patient selection process is emphasized and aids in the outcome of this rare procedure.…”

A Comparative Study of Total Knee Arthroplasty Outcome for Stiff Knee with or without Sequential Antirheumatic Drug Treatment

“…During exposure, stiff knees may need a rectus snip for exposure. Knees with osseous ankylosis in extension almost always need VY quadricepsplasty before the patella can be everted to minimize the risk of patellar tendon avulsion 11 . Aglietti and Buzzi recommended early quadricepsplasty to aid in exposure and patellar eversion without compromising the integrity of the patellar tendon 3 .…”

Application of the Ilizarov technique for knee joint arthrodesis as a treatment for end-stage tuberculosis of the knee

“…Most are young or middle-aged, and arthrodesis can be used as a transitional operation to control inflammation. After inflammation is controlled, a second-stage knee replacement can be selected to restore joint function, whereas the first-stage knee arthroplasty has a higher cost and is accompanied by a higher risk of TB recurrence [23,24]. In addition, for people with economic difficulties, especially for older patients, arthrodesis can also be used as the final treatment to relieve pain and improve quality of life.…”