Total Knee Arthroplasty for Neuropathic (Charcot) Joints
- 1 November 2003
- journal article
- section i-symposium
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics & Related Research
- Vol. 416 (416), 145-150
- https://doi.org/10.1097/01.blo.0000081937.75404.ed
Abstract
The clinical and radiographic results of 40 modern design condylar total knee arthroplasties (TKAs) in 29 patients with a confirmed diagnosis of Charcot joint were reviewed. The followup averaged 7.9 years (range, 2–15 years) for clinical and 6.4 years (range, 2–15) for radiographic surveillance. There was a significant improvement in Knee Society pain and function scores and ROM after knee arthroplasty. Extensive bone fragmentation and bone defect was present in 38 knees (95%). Metal wedge augments (10 knees, eight patient), autologous bone grafting (17 knees, 13 patients), and bone allografts (two knees, two patients) were used to reinforce the bony defects. Ligamentous instability necessitated the use of long stem components in 27 knees and rotating hinge prostheses in five knees. There were six reoperations for periprosthetic fracture (two knees, two patients), aseptic loosening (two knees, two patients), instability (one knee, one patient), and deep infection (one knee, one patient). Total knee arthroplasty may be offered to a select group of patients with end-stage neuropathic arthropathy. The basic principles of knee arthroplasty in restoring limb alignment, reinforcing bony defects by bone grafting or augmented prostheses, careful ligamentous balancing, and appropriate selection of constrained prostheses particularly are important in these patients. The technical challenges encountered during TKA in patients with neuropathic arthropathy, particularly in those with significant deformities, can require skills, implant systems, and methods usually reserved for complex revision arthroplasty.Keywords
This publication has 14 references indexed in Scilit:
- Total knee arthroplasty in a patient with bilateral charcot kneesArchives Of Physical Medicine and Rehabilitation, 1997
- Selective ablation of rat knee joint innervation with injected immunotoxin: A potential new model for the study of neuropathic arthritisJournal of Orthopaedic Research, 1997
- Imaging features of dissecting neuropathic jointsAustralasian Radiology, 1995
- Total knee arthroplasty in Charcot's jointThe Journal of Arthroplasty, 1993
- Rationale, of The Knee Society Clinical Rating SystemClinical Orthopaedics and Related Research, 1989
- The Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring SystemClinical Orthopaedics and Related Research, 1989
- Radiographic analysis of the axial alignment of the lower extremity.The Journal of Bone & Joint Surgery, 1987
- Total Knee Arthroplasty in Charcot and Charcot-like JointsPublished by Ovid Technologies (Wolters Kluwer Health) ,1986
- Geometric Total Knee ArthroplastyPublished by Ovid Technologies (Wolters Kluwer Health) ,1973
- NEURITIC MANIFESTATIONS IN DIABETES MELLITUSArchives of Internal Medicine, 1936