Total knee arthroplasty in patient with poliomyelitis sequelae: maintaining a recurvatum is associated with better mid-term functional results

IF 2 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2024-12-18 DOI:10.1007/s00402-024-05708-5

Grégoire Rougereau, Bernard Hollier-Larousse, Vincent Carpentier, Thomas Bauer, François Genêt, Marjorie Salga, Fabien Cale

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Abstract

Purpose

Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underwent TKA; (2) to examine risk factors for poor functional outcome.

Methods

A monocentric retrospective cohort study of all patients with poliomyelitis sequelae who underwent TKA between January 2006 and December 2019. Clinical, functional outcomes, radiographic results and occurrence of complications were collected.

Results

A total of 22 patients (24 knees) were included in the analysis, with a mean follow-up of 6.6 years (from 2 to 13.7 years). There was an improvement in KSS (28 +/- 23 vs. 81 +/- 6, respectively; p < 0.0001) as well as functional KSS (25 +/- 12 vs. 57.5 +/- 21, respectively; p = 0.0001). There was less occurrence of annual knee giving way episodes after total knee replacement (11.9+/-16.1 vs. 5.1+/-13.7, respectively; p = 0.04). Even though the total knee replacement allowed a slight recurvatum, it was smaller than the preoperative recurvatum (13° vs. 8°, respectively; p = 0.04). Seven complications with reintervention (7/24; 29%) were found. The presence of a residual post operative recurvatum correlated with better KSS (ρ = 0.53, CI95% [0.15; 0.77]; p = 0.008). The number of postoperative annual knee giving way episodes was inversely correlated with persistent postoperative recurvatum (ρ = -0.42, CI95% [-0.69; -0.01]; p = 0.04) but was not correlated with the type of constraint (ρ = -0.26, CI95% [-0.6; 0.15]; p = 0.21) nor with quadricipital muscle strength (ρ = 0.21, CI95% [-0.21; 0.56]; p = 0.33).

Conclusion

TKA has a good mid-term functional outcome for knee osteoarthritis in patients with sequelae of poliomyelitis. Preserving a residual recurvatum postoperatively gives better clinical results without increasing the risk of ligament instability or early aseptic loosening.

Level of evidence

IV.

Abstract Image

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脊髓灰质炎后遗症患者的全膝关节置换术：维持膝关节复排与较好的中期功能结果相关

目的脊髓灰质炎后遗症患者的全膝关节置换术（TKA）是一个手术挑战，因为肌肉无力，骨畸形或脊髓灰质炎后综合征（PPS）。很少有数据可以确定导致不良功能结果的因素。本研究的目的是：(1)描述脊髓灰质炎后遗症患者接受TKA的队列；(2)检查功能预后不良的危险因素。方法对2006年1月至2019年12月接受TKA治疗的脊髓灰质炎后遗症患者进行单中心回顾性队列研究。收集临床、功能、影像学结果及并发症发生情况。结果共纳入22例患者（24个膝关节），平均随访6.6年（2 ~ 13.7年）。KSS改善（分别为28 +/- 23和81 +/- 6）；p < 0.0001)和功能性KSS(分别为25 +/- 12 vs. 57.5 +/- 21；p = 0.0001)。全膝关节置换术后每年膝关节让位发作的发生率较低（分别为11.9+/-16.1 vs. 5.1+/-13.7）；p = 0.04)。尽管全膝关节置换术允许轻微的膝内倾，但其比术前的膝内倾要小(分别为13°和8°；p = 0.04)。再干预并发症7例(7/24；29%)。术后残余返曲的存在与较好的KSS相关(ρ = 0.53, CI95% [0.15；0.77);p = 0.008)。术后每年膝关节退行次数与术后持续复发呈负相关(ρ = -0.42, CI95% [-0.69；-0.01);p = 0.04)，但与约束类型无关(ρ = -0.26, CI95% [-0.6；0.15);p = 0.21)与头四头肌力量无关(ρ = 0.21, CI95% [-0.21；0.56);p = 0.33)。结论tka治疗脊髓灰质炎后遗症膝骨性关节炎中期功能预后良好。术后保留残余的反曲面可以获得更好的临床效果，而不会增加韧带不稳定或早期无菌性松动的风险。证据水平：

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).