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Total knee arthroplasty in patients with ipsilateral fused hip: a technical note.

Goodman SB, Huddleston JI, Hur D, Song SJ - Clin Orthop Surg (2014)

Bottom Line: The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky.The final outcome provided satisfactory results at a minimum of 2 years postoperatively.TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.

ABSTRACT
We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90° to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.

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Postoperative radiographs of case 2. Total knee arthroplasty was performed in a 63-year-old man with an ipsilateral fused hip in satisfactory position. His infection history, soft tissue atrophy, and scarring around the fused hip made total hip arthroplasty prior to the total knee arthroplasty risky. Positioning of the implants and alignment of the lower extremity were satisfactory.
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Figure 3: Postoperative radiographs of case 2. Total knee arthroplasty was performed in a 63-year-old man with an ipsilateral fused hip in satisfactory position. His infection history, soft tissue atrophy, and scarring around the fused hip made total hip arthroplasty prior to the total knee arthroplasty risky. Positioning of the implants and alignment of the lower extremity were satisfactory.

Mentions: A 63-year-old man had a left hip fracture and left upper extremity amputation due to war injuries. He underwent left hip fusion, but it became infected. He was hospitalized intermittently and in and out of a spica cast for several years. He had four operations to finally obtain an arthrodesis at 41 years. The skin and soft tissues around the hip were so atrophic and scarred that conversion of the hip fusion to THA was not considered a safe option. TKA was performed successfully with the surgical technique described previously. The clinical and radiographic results were satisfactory at the 7.8 years postoperative, although severe quadriceps scarring limited flexion (Table 1, Fig. 3).


Total knee arthroplasty in patients with ipsilateral fused hip: a technical note.

Goodman SB, Huddleston JI, Hur D, Song SJ - Clin Orthop Surg (2014)

Postoperative radiographs of case 2. Total knee arthroplasty was performed in a 63-year-old man with an ipsilateral fused hip in satisfactory position. His infection history, soft tissue atrophy, and scarring around the fused hip made total hip arthroplasty prior to the total knee arthroplasty risky. Positioning of the implants and alignment of the lower extremity were satisfactory.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233229&req=5

Figure 3: Postoperative radiographs of case 2. Total knee arthroplasty was performed in a 63-year-old man with an ipsilateral fused hip in satisfactory position. His infection history, soft tissue atrophy, and scarring around the fused hip made total hip arthroplasty prior to the total knee arthroplasty risky. Positioning of the implants and alignment of the lower extremity were satisfactory.
Mentions: A 63-year-old man had a left hip fracture and left upper extremity amputation due to war injuries. He underwent left hip fusion, but it became infected. He was hospitalized intermittently and in and out of a spica cast for several years. He had four operations to finally obtain an arthrodesis at 41 years. The skin and soft tissues around the hip were so atrophic and scarred that conversion of the hip fusion to THA was not considered a safe option. TKA was performed successfully with the surgical technique described previously. The clinical and radiographic results were satisfactory at the 7.8 years postoperative, although severe quadriceps scarring limited flexion (Table 1, Fig. 3).

Bottom Line: The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky.The final outcome provided satisfactory results at a minimum of 2 years postoperatively.TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA.

ABSTRACT
We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90° to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.

Show MeSH
Related in: MedlinePlus