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Bilateral knee arthrodesis in a patient with common variable immunodeficiency
Afraaz R Irani1, Bradley P Graw, Stuart B Goodman
1Stanford University, Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, California, USA.
The Journal of Arthroplasty
|September 5, 2009
Summary
Common variable immunodeficiency patients may develop severe arthritis. Knee arthroplasty in these patients carries a high infection risk, potentially leading to bone fusion (arthrodesis) rather than joint replacement.
Area of Science:
- Immunology
- Orthopedic Surgery
- Rheumatology
Background:
- Common variable immunodeficiency (CVID) can manifest with severe joint disease, including debilitating arthritis.
- Knee arthritis poses significant challenges for patients, impacting mobility and quality of life.
Observation:
- A 42-year-old male with CVID presented with bilateral knee arthritis.
- He underwent a right total knee arthroplasty complicated by infection, followed by spontaneous leg fusion in extension.
- His left knee had limited motion (90°-110°), prompting a request for noninstrumented arthrodesis.
Findings:
- The patient ultimately achieved bilateral knee arthrodeses.
- He now ambulates with the assistance of a cane.
Implications:
- Total knee arthroplasty in CVID patients carries an elevated risk of infection.
- Infection may necessitate conversion to knee arthrodesis, potentially without the need for instrumentation.
- Arthrodesis may be a viable, albeit less ideal, outcome for managing severe knee arthritis in immunocompromised individuals.
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