Revision total knee arthroplasty with Charcot-Marie-Tooth disease - a case report

Introduction and importance

Charcot-Marie-Tooth (CMT) disease is a rare hereditary neuropathy characterized by progressive distal muscle weakness and altered gait biomechanics. Total knee arthroplasty (TKA) in CMT patients can be challenging, as little is known about long-term outcomes. This case highlights the need for pre-operative planning and structured follow-up of patients with CMT who underwent TKA, as loosening might occur at an early stage.

Case presentation

A 72-year-old woman with advanced CMT disease presented with disabling pain and multidirectional instability ten years after a primary TKA. Radiographic evaluation revealed severe aseptic loosening and extensive metaphyseal bone loss. Revision surgery was performed in a one-stage approach using a rotating-hinge TKA with tibial metaphyseal augmentation. The patient experienced excellent recovery and functional improvement. One-stage revision to a rotating-hinge TKA demonstrated a favourable outcome at 3 years.

Clinical discussion

Patients with CMT may present with multiplanar joint instability and abnormal gait, placing increased stress on standard condylar implants and accelerating loosening. In such cases, standard implants may not be appropriate. Early consideration of stemmed or constrained implants may improve stability and durability. Revision surgery may be further complicated by bone loss and instability, warranting the use of rotating-hinged TKA systems. Close postoperative monitoring is critical to detect complications early in this high-risk population.

Conclusion

CMT-related neuromuscular dysfunction may predispose to early TKA failure. This case underlines the importance of preoperative planning and long-term follow-up. When major bone loss and instability are present, revision to a rotating-hinged TKA offers a reliable and durable solution.