Document Detail


Technical challenges of total knee arthroplasty in skeletal dysplasia.
MedLine Citation:
PMID:  20706808     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Total knee arthroplasty (TKA) in patients with skeletal dysplasias is particularly challenging as a result of the anatomic variances and substantial bony deformities. Little has been written regarding technical considerations that should be made when performing TKA in skeletal dysplasia.
QUESTIONS/PURPOSES: We describe special operative considerations that must be made when performing TKA on patients with skeletal dysplasia, including implant selection and ligamentous balancing.
PATIENTS AND METHODS: We retrospectively reviewed 12 TKAs in eight patients with varying degrees of deformity (ranging from 30° of varus to 45° of valgus) secondary to three types of skeletal dysplasias: multiple hereditary exostosis, achondroplasia, and osteogenesis imperfecta. Clinical notes, operative records, and radiographic data were reviewed. Minimum followup was 1 year (average, 4 years; range, 1-10 years).
RESULTS: We used customized implants in three of the 12 knees. Constrained tibial inserts were used in five knees. All 12 knees underwent releases (soft tissue or epicondylar osteotomy) to address gap balancing or patellar tracking. Average Knee Society scores improved from 35.9 preoperatively to 82.9 postoperatively and average function scores improved from 47.9 preoperatively to 96.7 postoperatively. Complications included two transient peroneal nerve palsies.
CONCLUSIONS: Special considerations must be made with regard to implant selection and ligamentous balancing as a result of the unusual anatomy and deformities that accompany skeletal dysplasia, but the short-term clinical results reveal consistent improvements in pain and function.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Raymond H Kim; Giles R Scuderi; Douglas A Dennis; Steven W Nakano
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  469     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-25     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-75     Citation Subset:  AIM; IM    
Affiliation:
Colorado Joint Replacement, 2535 S Downing Street, Suite 100, Denver, CO 80210, USA. rkim@co-ortho.com
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MeSH Terms
Descriptor/Qualifier:
Achondroplasia / complications
Adult
Aged
Aged, 80 and over
Arthritis / complications,  physiopathology,  radiography,  surgery*
Arthroplasty, Replacement, Knee / adverse effects*,  instrumentation
Biomechanics
Bone Diseases, Developmental / complications*,  physiopathology,  radiography
Colorado
Exostoses, Multiple Hereditary / complications
Female
Humans
Knee Joint / physiopathology,  radiography,  surgery*
Knee Prosthesis
Male
Middle Aged
New York City
Osteogenesis Imperfecta / complications
Pain Measurement
Pain, Postoperative / etiology,  prevention & control
Patient Selection*
Prosthesis Design
Range of Motion, Articular
Recovery of Function
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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