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Everything You Always Wanted to Know about TKR in Ankylosed Knee* (*But Were Afraid to Ask)

February 19, 2016

Contributors: Matteo Bruzzone, MD; Roberto Rossi, MD; Federica Rosso, MD; Federico Dettoni, MD; Davide E Bonasia, MD; Umberto Cottino; Antongiulio Marmotti, MD; Davide Blonna, MD

An ankylosed knee by description is defined as a knee with less than a 30° arc of movement. Knee joint may be ankylosed in flexion because of contracture of posterior soft-tissue structures or after previous surgical procedures (i.e. high tibial osteotomy) or juxta-articular adhesions; or it may be ankylosed in extension because of extensor mechanism shortening (quadriceps contracture, patella baja), heterotopic ossification, or intra-articular adhesions. Performing a total knee arthroplasty in ankylosed knee can be one of the most difficult surgical challenges even for an expert joint surgeon. Literature reports a 14 to 45% of complications, and an average expected range of movement from 60 to 75 degrees. Knowing the etiology of ankylosed knee is fundamental, such as ruling out infection. In this video we present a complex case of an ankylosed knee in a hemophilic patient, analyzing in a stepped way all the main problems we had to deal with during surgery: difficult exposure and extensor mechanism shortening associated with patello-femoral fusion, definition of anatomic landmarks and joint line, fine tuning in soft tissues releases, and choice of implant constraint necessary to obtain a mobile but contemporary stable knee. In long standing stiffness or ankylosis, disuse osteoporosis frequently occurs, which may further jeopardize ligament attachment strength and may bring the knee at risk for ligament avulsion on attempted flexion. Moreover, because of the potential to have a flexion-extension gap mismatch and preoperative and/or intraoperative ligamentous dysfunction, we recommend to have a full revision armamentarium including more constrained systems, smaller implants, stem extensions, augments, sleeves, offset stems, and wedges in the operating room. In all cases, expectations of both surgeon and patient must be realistic and clearly defined prior to surgery to improve results and satisfaction.

Results for "Primary Knee Arthroplasty"

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