Total Knee Arthroplasty in Postpolio Residual Paralysis: A Systematic Review and Pooled Analysis of Its Outcomes and...

Total knee arthroplasty (TKA) in patients who have postpolio residual paralysis (PPRP) is technically challenging due to bone deformities, ligamentous laxity, and variable quadriceps muscle strength. Despite these challenges, TKA is increasingly being performed in this population, yet outcomes remain variably reported. This review aimed to systematically assess postoperative complications and revision rates following TKA in patients who had PPRP through a pooled analysis of available studies.

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases including PubMed, Embase, and Scopus were searched using the strategy ((total knee arthroplasty) OR (total knee replacement)) AND ((polio) OR (poliomyelitis)). A total of 12 studies comprising 272 knees were included. Data on demographics, knee characteristics, complications, and revision rates were extracted. Pooled proportions with 95% confidence intervals (CIs) were calculated using a random-effects model with the Freeman-Tukey double arcsine transformation, and heterogeneity was assessed using the I² statistic.

The overall pooled complication rate was 16% (95% CI, 9 to 26), with instability or residual recurvatum (5%) and periprosthetic fractures (2%) being the most common. Other complications, including component-related fractures, infection, quadriceps muscle-related issues, stiffness, aseptic loosening, mechanical failure, and deep vein thrombosis, were rare (< 3%). Revision surgery occurred in 8% of knees (95% CI, 4 to 15%. Heterogeneity among studies was moderate to high for complications and revisions (I² = 58 to 72%, P ≤ 0.01), reflecting variability in outcomes across cohorts.

Total knee arthroplasty in PPRP provides satisfactory outcomes, but is associated with a notable risk of postoperative complications and a moderate revision rate. Instability, recurvatum, and periprosthetic fracture remain key concerns, underscoring the importance of meticulous preoperative planning and the selection of tailored implants.