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Total knee arthroplasty for neuropathic (Charcot) joints
Javad Parvizi1, Jeffrey Marrs, Bernard F Morrey
1Rothman Institute at Jefferson, Philadelphia, PA, USA.
Clinical Orthopaedics and Related Research
|December 4, 2003
Summary
Total knee arthroplasty (TKA) significantly improved pain and function in patients with Charcot joint. Careful surgical techniques and implants are crucial for managing bone defects and instability in these complex cases.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- Charcot joint, a form of neuropathic arthropathy, presents significant challenges for total knee arthroplasty (TKA).
- Patients often exhibit extensive bone fragmentation and defects, complicating surgical reconstruction.
Purpose of the Study:
- To evaluate the clinical and radiographic outcomes of modern condylar total knee arthroplasties (TKAs) in patients with Charcot joint.
- To identify key surgical principles and challenges in performing TKA for neuropathic arthropathy.
Main Methods:
- Review of clinical and radiographic results of 40 TKAs in 29 patients with Charcot joint.
- Follow-up averaged 7.9 years for clinical and 6.4 years for radiographic assessment.
- Analysis of techniques used for bone defects (augments, grafts) and instability (long stems, rotating hinges).
Main Results:
- Significant improvements in Knee Society pain and function scores and range of motion (ROM) were observed post-TKA.
- 95% of knees had extensive bone fragmentation or defects, requiring augmentation or grafting.
- Six reoperations were performed for periprosthetic fracture, aseptic loosening, instability, and deep infection.
Conclusions:
- Total knee arthroplasty can be a viable option for select patients with end-stage neuropathic arthropathy.
- Restoring alignment, reinforcing bone defects, ligamentous balancing, and selecting constrained prostheses are critical.
- TKA in these patients presents technical challenges often requiring complex revision arthroplasty techniques.