Total knee arthroplasty in neuropathic arthropathy

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Infectious Diseases

Background:

• Neurosyphilitic Charcot arthropathy is a rare but severe condition affecting the joints.
• It can lead to significant joint destruction and instability, posing challenges for treatment.

Purpose of the Study:

• To evaluate the outcomes of total knee arthroplasty (TKA) in patients with severe neurosyphilitic Charcot arthropathy.
• To assess the efficacy and complication rates of TKA in this specific patient population.

Main Methods:

• A retrospective review of ten patients (19 knees) who underwent TKA for neurosyphilitic Charcot arthropathy.
• Utilized cemented condylar, constrained prostheses in most cases.
• Follow-up averaged 5.2 years, with outcomes assessed using the Hospital for Special Surgery score.

Main Results:

• Mean Hospital for Special Surgery knee scores improved significantly from 36.5 pre-operatively to 76 post-operatively.
• However, a high complication rate was observed: 16% aseptic loosening, 31% poor function, and 53% satisfactory outcomes.
• Three knees required arthrodesis due to aseptic loosening.

Conclusions:

• Total knee arthroplasty can improve function in neurosyphilitic Charcot arthropathy.
• The procedure carries a high risk of serious complications, including aseptic loosening and poor functional outcomes.
• Charcot arthropathy is not an absolute contraindication for TKA, but careful patient selection and surgical planning are crucial.