Outcome of total knee arthroplasty in patients with poliomyelitis

Abstract

Total knee arthroplasty (TKA) in patients affected by poliomyelitis is technically challenging owing to abnormal anatomical features including articular and metaphyseal angular deformities, external rotation of the tibia, excessive valgus alignment, bone loss, narrowness of the femoral and tibial canals, impaired quadriceps strength, flexion contractures, genu recurvatum and ligamentous laxity. Little information is available regarding the results and complications of TKA in this challenging group of patients.We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of TKA in patients with poliomyelitis-affected knees. Six studies including 82 knees met the inclusion criteria and were reviewed. The mean patient age was 63 years (45 to 85) and follow-up was 5.5 years (0.5 to 13).All studies reported significant improvement in knee function following TKA. There were six failures requiring revision surgery in 82 cases (7%) occurring at a mean of 6.2 years (0.4 to 12). The reasons for revision surgery were aseptic loosening (17%, n=1), infection (33%, n=2), periprosthetic fracture (17%, n=1) and instability (33%, n=2). Thirty-six knees had a degree of recurvatum pre-operatively (44%), which was in the range of 5° to 30°. Ten of these knees (28%) developed recurrent recurvatum post-operatively.The findings support the use of TKA in patients with poliomyelitis-affected knees. The post-operative functional outcome is similar to other patients; however, the revision rate is higher. Quadriceps muscle power appears to be an important prognostic factor for functional outcome and the use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength.Cite this article: EFORT Open Rev 2018;3:358-362. DOI: 10.1302/2058-5241.3.170028

The role of rotating hinge implants in revision total knee arthroplasty

“…59,60 The rotational aspect of the hinge is necessary except in very rare neurological cases where the movement must be restricted to flexion–extension. 61…”

Análisis biomecánico de la marcha en paciente con secuelas de poliomielitis y artroplastia de rodilla

“…Esto podría deberse al reto técnico que supone una ATR en pacientes con secuelas de poliomielitis en los que generalmente se presentan, como se mencionó anteriormente, deformidades articulares y metafisarias, aumentada rotación tibial externa, valgos excesivo, pobre calidad del hueso, genu-recurvatum y laxitud ligamentosa, características que pueden alterar los procesos intrínsecos de la cirugía, como la realización de los canales para los vástagos tibial y femoral (1-2). También así la colocación adecuada de dichos vástagos y el fraguado del cemento, que al tratarse habitualmente de huesos osteopénicos, puede generar con facilidad alteraciones no deseadas en la alineación del el elemento protésico (8).…”

“…La fuerza muscular del cuádriceps parece ser un factor pronóstico importante para los resultados funcionales y cuando esta es menor que la antigravitatoria, el uso de implantes constreñidos está recomendado (8). Además, el uso de implantes abisagrados está indicado en pacientes más severamente afectados con pobre fuerza muscular que no proporciona estabilidad intrínseca, aumentando el riesgo de recurrencia de hiperextensión de rodilla y laxitud ligamentosa (9).…”

Total knee replacement in a patient with quadriceps paresis secondary to polio: A case report

“…Tigani et al [4] had justified that modern day implants with RHK designs mimics normal kinematics of knee with reduced stress on implant bone interface. In one study [5] , it suggested that if quadriceps power in less than antigravity strength (<3/5), Results with hinged design are better than conventional design.…”