Total Knee Replacement in Patients with Ankylosis. Report of Three Cases and Literature Review
Article Sidebar
Published:
Aug 19, 2021
Keywords:
Ankylosis, knee, arthroplasty
Main Article Content
Abstract
Introduction: Performing a Total Knee Replacement (TKR) in patients with ankylosed knees is technically demanding and associated with considerable complications. The purpose of this study is to report three cases of patients with ankylosed knees treated with TKR and present an updated literature review.
Materials and Methods: We evaluated etiologies, preoperative range of motion, surgical technique, and type of implant utilized in each case. Complications and postoperative range of motion were also analyzed. Radiographs were used to evaluate loosening or osteolysis. Lastly, we performed an updated literature review.
Results: The etiologies were juvenile rheumatoid arthritis in two cases and chronic osteomyelitis in one. The patients did not have a range of motion at all and the ability to perform daily life activities was severely affected. A medial parapatellar approach was used in all cases followed by an extensive soft tissue release. A primary posterior-stabilized design was used in two cases and a rotatinghinge design in one case. The mean postoperative range of motion was 90° and all three patients reported a high satisfaction rate. No complications were reported.
Conclusions: TKR in patients with ankylosed knees has substantially improved the clinical outcome and the arc of motion. Due to its complexity, it must be approached as revision surgery, with careful preoperative planning.
Materials and Methods: We evaluated etiologies, preoperative range of motion, surgical technique, and type of implant utilized in each case. Complications and postoperative range of motion were also analyzed. Radiographs were used to evaluate loosening or osteolysis. Lastly, we performed an updated literature review.
Results: The etiologies were juvenile rheumatoid arthritis in two cases and chronic osteomyelitis in one. The patients did not have a range of motion at all and the ability to perform daily life activities was severely affected. A medial parapatellar approach was used in all cases followed by an extensive soft tissue release. A primary posterior-stabilized design was used in two cases and a rotatinghinge design in one case. The mean postoperative range of motion was 90° and all three patients reported a high satisfaction rate. No complications were reported.
Conclusions: TKR in patients with ankylosed knees has substantially improved the clinical outcome and the arc of motion. Due to its complexity, it must be approached as revision surgery, with careful preoperative planning.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Pérez Abdala, J. I., García-Mansilla, I., Nicolino, T. I., Yacuzzi, C., Carbó, L., Costantini, J., & Costa Paz, M. (2021). Total Knee Replacement in Patients with Ankylosis. Report of Three Cases and Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 519-528. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1383
Issue
Section
Clinical Research
Copyright (c) 2021 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Lange T, Schmitt J, Kopkow C, Rataj E, Günther K-P, Lützner J. What do patients expect from total knee
arthroplasty? A Delphi Consensus Study on Patient Treatment Goals. J Arthroplasty 2017; 32:2093-9.e1.
https://doi.org/10.1016/j.arth.2017.01.053
2. Bradley GW, Freeman MA, Albrektsson BE. Total prosthetic replacement of ankylosed knees. J Arthroplasty
1987;2(3):179-83. https://doi.org/10.1016/s0883-5403(87)80035-9
3. Hsu CH, Lin PC, Chen WS, Wang JW. Total knee arthroplasty in patients with stiff knees. J Arthroplasty
2012;27(2):286-92. https://doi.org/10.1016/j.arth.2011.05.001
4. Gatha NM, Clarke HD, Fuchs R, Scuderi GR, Insall JN. Factors affecting postoperative range of motion after total
knee arthroplasty. J Knee Surg 2004;17(4):196-202. https://doi.org/10.1055/s-0030-1248221
5. Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA. Factors affecting the range of movement of total knee
arthroplasty. J Bone Joint Surg Br 1993;75(6):950-5. https://doi.org/10.1302/0301-620x.75b6.8245090
6. Bhan S, Malhotra R, Kiran EK. Comparison of total knee arthroplasty in stiff and ankylosed knees. Clin Orthop
Relat Res 2006;451:87-95. https://doi.org/10.1097/01.blo.0000229313.20760.13
7. Kim Y-H, Kim J-S. Does TKA improve functional outcome and range of motion in patients with stiff knees? Clin
Orthop Relat Res 2009;467(5):1348-54. https://doi.org/10.1007/s11999-008-0445-7
8. Kim YH, Kim JS, Cho SH. Total knee arthroplasty after spontaneous osseous ankylosis and takedown of formal
knee fusion. J Arthroplasty 2000;15(4):453-60. https://doi.org/10.1054/arth.2000.4640
9. Bae DK, Yoon KH, Kim HS, Song SJ. Total knee arthroplasty in stiff knees after previous infection. J Bone Joint
Surg Br 2005;87(3):333-6. https://doi.org/10.1302/0301-620x.87b3.15457
10. Aglietti P, Windsor RE, Buzzi R, Insall JN. Arthroplasty for the stiff or ankylosed knee. J Arthroplasty 1989;4(1):1-5. https://doi.org/10.1016/s0883-5403(89)80046-4
11. Fosco M, Filanti M, Amendola L, Savarino LM, Tigani D. Total knee arthroplasty in stiff knee compared with
flexible knees. Musculoesquelet Surg 2011;95(1):7-12. https://doi.org/10.1007/s12306-011-0099-6
12. Rajgopal A, Panda I, Dahiya V. A Comparative study on the long-term outcome of total knee arthroplasty performed for knees stiff in extension and those stiff in flexion. J Arthroplasty 2017;32(11):3396-403.
https://doi.org/10.1016/j.arth.2017.06.027
13. Polascik BW, Bin Abd Razak HR, Chong H-C, Lo N-N, Yeo S-J. Acceptable functional outcomes and patient
satisfaction following total knee arthroplasty in asians with severe knee stiffness: A matched analysis. Clin Orthop Surg 2018;10(3):337-43. https://doi.org/10.4055/cios.2018.10.3.337
14. Kovalak E, Can A, Stegemann N, Erdoğan AÖ, Erdoğan F. Total knee arthroplasty after osseous ankylosis of the knee joint. Acta Orthop Traumatol Turc 2015;49(5):503-7. https://doi.org/10.3944/AOTT.2015.14.0304
15. Camanho GL. Total arthroplasty in ankylosed knees: a case series. Clinics 2009;64(3):183-7.
https://doi.org/10.1590/s1807-59322009000300006
16. Naranja RJ Jr, Lotke PA, Pagnano MW, Hanssen AD. Total knee arthroplasty in a previously ankylosed or
arthrodesed knee. Clin Orthop Relat Res 1996;(331):234-7. https//doi.org/10.1097/00003086-199610000-00033
17. Kim H-J, Mun J-U, Kim K-H, Kyung H-S. Total knee arthroplasty conversion for patients with ankylosed knees. J
Orthop Surg 2017;25(1):2309499016684095. https://doi.org/10.1177/2309499016684095
18. Bittelman S, Nemtala F, Salvo N, Araya R, Devia B, Voss C, et al. Prótesis de rodilla en pacientes con anquilosis.
Revista Acaro 2019;5(2):31-4. Disponible en: http://acaro.org.ar/acarorevista/images/revistas/05_02/AC_05_02_v6.pdf
19. Rajgopal A, Ahuja N, Dolai B. Total knee arthroplasty in stiff and ankylosed knees. J Arthroplasty 2005;20(5):585-90. https://doi.org/10.1016/j.arth.2005.04.002
20. Kim Y-H, Kim J-S. Total knee replacement for patients with ankylosed knees. J Bone Joint Surg Br 2008;90(10):
1311-6. https://doi.org/10.1302/0301-620X.90B10.20857
21. McAuley JP, Harrer MF, Ammeen D, Engh GA. Outcome of knee arthroplasty in patients with poor preoperative range of motion. Clin Orthop Relat Res 2002;404:203-7. https://doi.org/10.1097/00003086-200211000-00033
22. Cho SH, Jeong ST, Park HB, Hwang SC, Kim DH. Two-stage conversion of fused knee to total knee arthroplasty. J Arthroplasty 2008;23(3):476-9. https://doi.org/10.1016/j.arth.2007.06.013
arthroplasty? A Delphi Consensus Study on Patient Treatment Goals. J Arthroplasty 2017; 32:2093-9.e1.
https://doi.org/10.1016/j.arth.2017.01.053
2. Bradley GW, Freeman MA, Albrektsson BE. Total prosthetic replacement of ankylosed knees. J Arthroplasty
1987;2(3):179-83. https://doi.org/10.1016/s0883-5403(87)80035-9
3. Hsu CH, Lin PC, Chen WS, Wang JW. Total knee arthroplasty in patients with stiff knees. J Arthroplasty
2012;27(2):286-92. https://doi.org/10.1016/j.arth.2011.05.001
4. Gatha NM, Clarke HD, Fuchs R, Scuderi GR, Insall JN. Factors affecting postoperative range of motion after total
knee arthroplasty. J Knee Surg 2004;17(4):196-202. https://doi.org/10.1055/s-0030-1248221
5. Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA. Factors affecting the range of movement of total knee
arthroplasty. J Bone Joint Surg Br 1993;75(6):950-5. https://doi.org/10.1302/0301-620x.75b6.8245090
6. Bhan S, Malhotra R, Kiran EK. Comparison of total knee arthroplasty in stiff and ankylosed knees. Clin Orthop
Relat Res 2006;451:87-95. https://doi.org/10.1097/01.blo.0000229313.20760.13
7. Kim Y-H, Kim J-S. Does TKA improve functional outcome and range of motion in patients with stiff knees? Clin
Orthop Relat Res 2009;467(5):1348-54. https://doi.org/10.1007/s11999-008-0445-7
8. Kim YH, Kim JS, Cho SH. Total knee arthroplasty after spontaneous osseous ankylosis and takedown of formal
knee fusion. J Arthroplasty 2000;15(4):453-60. https://doi.org/10.1054/arth.2000.4640
9. Bae DK, Yoon KH, Kim HS, Song SJ. Total knee arthroplasty in stiff knees after previous infection. J Bone Joint
Surg Br 2005;87(3):333-6. https://doi.org/10.1302/0301-620x.87b3.15457
10. Aglietti P, Windsor RE, Buzzi R, Insall JN. Arthroplasty for the stiff or ankylosed knee. J Arthroplasty 1989;4(1):1-5. https://doi.org/10.1016/s0883-5403(89)80046-4
11. Fosco M, Filanti M, Amendola L, Savarino LM, Tigani D. Total knee arthroplasty in stiff knee compared with
flexible knees. Musculoesquelet Surg 2011;95(1):7-12. https://doi.org/10.1007/s12306-011-0099-6
12. Rajgopal A, Panda I, Dahiya V. A Comparative study on the long-term outcome of total knee arthroplasty performed for knees stiff in extension and those stiff in flexion. J Arthroplasty 2017;32(11):3396-403.
https://doi.org/10.1016/j.arth.2017.06.027
13. Polascik BW, Bin Abd Razak HR, Chong H-C, Lo N-N, Yeo S-J. Acceptable functional outcomes and patient
satisfaction following total knee arthroplasty in asians with severe knee stiffness: A matched analysis. Clin Orthop Surg 2018;10(3):337-43. https://doi.org/10.4055/cios.2018.10.3.337
14. Kovalak E, Can A, Stegemann N, Erdoğan AÖ, Erdoğan F. Total knee arthroplasty after osseous ankylosis of the knee joint. Acta Orthop Traumatol Turc 2015;49(5):503-7. https://doi.org/10.3944/AOTT.2015.14.0304
15. Camanho GL. Total arthroplasty in ankylosed knees: a case series. Clinics 2009;64(3):183-7.
https://doi.org/10.1590/s1807-59322009000300006
16. Naranja RJ Jr, Lotke PA, Pagnano MW, Hanssen AD. Total knee arthroplasty in a previously ankylosed or
arthrodesed knee. Clin Orthop Relat Res 1996;(331):234-7. https//doi.org/10.1097/00003086-199610000-00033
17. Kim H-J, Mun J-U, Kim K-H, Kyung H-S. Total knee arthroplasty conversion for patients with ankylosed knees. J
Orthop Surg 2017;25(1):2309499016684095. https://doi.org/10.1177/2309499016684095
18. Bittelman S, Nemtala F, Salvo N, Araya R, Devia B, Voss C, et al. Prótesis de rodilla en pacientes con anquilosis.
Revista Acaro 2019;5(2):31-4. Disponible en: http://acaro.org.ar/acarorevista/images/revistas/05_02/AC_05_02_v6.pdf
19. Rajgopal A, Ahuja N, Dolai B. Total knee arthroplasty in stiff and ankylosed knees. J Arthroplasty 2005;20(5):585-90. https://doi.org/10.1016/j.arth.2005.04.002
20. Kim Y-H, Kim J-S. Total knee replacement for patients with ankylosed knees. J Bone Joint Surg Br 2008;90(10):
1311-6. https://doi.org/10.1302/0301-620X.90B10.20857
21. McAuley JP, Harrer MF, Ammeen D, Engh GA. Outcome of knee arthroplasty in patients with poor preoperative range of motion. Clin Orthop Relat Res 2002;404:203-7. https://doi.org/10.1097/00003086-200211000-00033
22. Cho SH, Jeong ST, Park HB, Hwang SC, Kim DH. Two-stage conversion of fused knee to total knee arthroplasty. J Arthroplasty 2008;23(3):476-9. https://doi.org/10.1016/j.arth.2007.06.013