Total knee arthroplasty in a patient with ipsilateral hip ankylosis

Abstract

Rationale:There is a large number of people that have knee degeneration in China. Total knee arthroplasty is one of the most effective methods of treatment in the later stages of the disease. However, there are challenges when performing total knee arthroplasty on patients with ipsilateral hip akylosis. So far, there are few reports on postoperative curative effect of total knee arthroplasty for these patients. This case report records how to perform total knee arthroplasty in a patient with ipsilateral hip ankylosis.Patient concerns:Due to ankylosing spondylitis, the flexion of the patient's hips are restricted in 10°, which leads to a limited ipsilateral knee flexion to 30° when she is in the supine position.Diagnoses:Right knee osteoarthritis; right hip ankylosis.Interventions:We modified the traditional surgical position to allow easy exposure of the knee during surgery. After total knee arthroplasty, the patient was included in a planned training program, and was followed for 6 months.Outcomes:The patient walked well without ambulation aid and achieved satisfactory knee joint function.Lessons:Conversion of a fused hip to a total hip arthroplasty does improve the quality of life of patients, but, given the high incidence of complications and more financial burden to the patient, we modified traditional surgical position of the patient to provide ideal surgical exposure of the knee. We hope that this case can be used as a reference for clinicians to deal with similar situations.

Total Knee Arthroplasty with Prior Ipsilateral Hip Arthrodesis

“…Previously reported good outcomes support the benefit of TKA regardless of whether the prior hip arthrodesis was left in place or converted to total hip arthroplasty before TKA [ [1] , [2] , [3] , [4] , [5] ]. Conversion of a hip fusion to total hip arthroplasty itself is a technically demanding procedure with a relatively high complication rate and may not be necessary before considering TKA [ 5 , 7 ].…”

“…TKA is one of the most common and successful surgical interventions provided by orthopaedic surgeons, which includes patients with prior ipsilateral hip arthrodesis [ [1] , [2] , [3] , [4] , [5] ]. Romness and Morrey previously demonstrated good outcomes for their case series of patients with prior ipsilateral hip arthrodesis or ankylosis with or without takedown of the fusion and conversion to total hip arthroplasty before knee replacement, with their focus on patient outcomes rather than technical guidance [ 1 ].…”

“…Koo et al subsequently reported on their use of a sandbag beneath the ipsilateral buttock and compensatory 20-degree tilt of the table toward the operated leg to facilitate 100 degrees of knee flexion during TKA with good surgical result [ 3 ]. Tang et al [ 4 ] reported on their experience on performing a TKA in a patient with ipsilateral hip ankylosis by modifying conventional positioning to suspend the operative knee from the end of the operating table. Compared with others' techniques, our novel positioning techniques allow the surgeon to complete TKA with standard equipment and less intraoperative variability.…”

“…Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature [ [1] , [2] , [3] , [4] , [5] ]. Hip arthrodesis is not routinely performed today; however, it can be a viable option in young patients with post-traumatic, postinfectious, or early-onset end-stage symptomatic hip arthritis.…”

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

“…Other authors have suggested using a sandbag under the ipsilateral buttock [7] or elevating the fused hip joint to allow the knee to flex up to 100° on the operating table, with a good surgical outcome. 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].…”