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Autosomal dominant type I osteopetrosis is related with iatrogenic fractures in arthroplasty.

van Hove RP, de Jong T, Nolte PA - Clin Orthop Surg (2014)

Bottom Line: Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts.A case of cementless total knee arthroplasty in a patient with ADO I is presented.Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Spaarne Hospital, Hoofddorp, The Netherlands.

ABSTRACT
Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.

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Preoperative radiographs of the right knee. (A) Anteroposterior view showing dense bone, narrowing of the lateral joint space, osteophytes in the lateral and medial plateau, and valgus alignment. (B) Lateral view showing dense bone, osteophytes at the patellofemoral joint and possible loose bodies.
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Figure 1: Preoperative radiographs of the right knee. (A) Anteroposterior view showing dense bone, narrowing of the lateral joint space, osteophytes in the lateral and medial plateau, and valgus alignment. (B) Lateral view showing dense bone, osteophytes at the patellofemoral joint and possible loose bodies.

Mentions: A 41-year-old female with Down syndrome and ADO I presented with a painful right knee and abnormal gait. She had no fracture history. Her only sister was also diagnosed with ADO I. On physical examination, there was effusion of the knee joint, with a correctable valgus deformity of 15° and flexion of 120°. Knee radiographs showed narrowing of the lateral and patellofemoral joint, osteophytes, loose bodies, and a dense bone structure (Fig. 1). Dual energy X-ray absorptiometry showed a bone mass density of 2.0 g/cm2 with a T-score of 6.8 for the lumbar vertebrae and a T-score of 7.5 for the right proximal femur. Lumbar spine radiographs showed no "rugger jersey spine," and pelvic radiographs showed no endobones. Skull radiographs and blood serum analysis for calcium, phosphate, acid phosphatase, and alkaline phosphatase were not performed. TKA was performed with a cementless mobile-bearing rotating platform total knee prosthesis. After extramedullary alignment, multiple saws were used to make the femoral and tibial cuts. The cementless prosthesis was extremely gently impacted. Nevertheless, a fissured fracture in the tibia occurred but was stable. Postoperative radiographs showed that the fissured fracture was distal to the cone of the tibial component (Fig. 2). Partial weight-bearing was allowed for 6 weeks after which the fissured fracture healed. Because of limited flexion to 90° at 3 months after surgery, the knee was mobilized under anesthesia. The patient was pain free, and knee flexion was 110° at 1 year after surgery. One-year postoperative radiographs showed no signs of the earlier fissured fracture (Fig. 3).


Autosomal dominant type I osteopetrosis is related with iatrogenic fractures in arthroplasty.

van Hove RP, de Jong T, Nolte PA - Clin Orthop Surg (2014)

Preoperative radiographs of the right knee. (A) Anteroposterior view showing dense bone, narrowing of the lateral joint space, osteophytes in the lateral and medial plateau, and valgus alignment. (B) Lateral view showing dense bone, osteophytes at the patellofemoral joint and possible loose bodies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233231&req=5

Figure 1: Preoperative radiographs of the right knee. (A) Anteroposterior view showing dense bone, narrowing of the lateral joint space, osteophytes in the lateral and medial plateau, and valgus alignment. (B) Lateral view showing dense bone, osteophytes at the patellofemoral joint and possible loose bodies.
Mentions: A 41-year-old female with Down syndrome and ADO I presented with a painful right knee and abnormal gait. She had no fracture history. Her only sister was also diagnosed with ADO I. On physical examination, there was effusion of the knee joint, with a correctable valgus deformity of 15° and flexion of 120°. Knee radiographs showed narrowing of the lateral and patellofemoral joint, osteophytes, loose bodies, and a dense bone structure (Fig. 1). Dual energy X-ray absorptiometry showed a bone mass density of 2.0 g/cm2 with a T-score of 6.8 for the lumbar vertebrae and a T-score of 7.5 for the right proximal femur. Lumbar spine radiographs showed no "rugger jersey spine," and pelvic radiographs showed no endobones. Skull radiographs and blood serum analysis for calcium, phosphate, acid phosphatase, and alkaline phosphatase were not performed. TKA was performed with a cementless mobile-bearing rotating platform total knee prosthesis. After extramedullary alignment, multiple saws were used to make the femoral and tibial cuts. The cementless prosthesis was extremely gently impacted. Nevertheless, a fissured fracture in the tibia occurred but was stable. Postoperative radiographs showed that the fissured fracture was distal to the cone of the tibial component (Fig. 2). Partial weight-bearing was allowed for 6 weeks after which the fissured fracture healed. Because of limited flexion to 90° at 3 months after surgery, the knee was mobilized under anesthesia. The patient was pain free, and knee flexion was 110° at 1 year after surgery. One-year postoperative radiographs showed no signs of the earlier fissured fracture (Fig. 3).

Bottom Line: Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts.A case of cementless total knee arthroplasty in a patient with ADO I is presented.Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Spaarne Hospital, Hoofddorp, The Netherlands.

ABSTRACT
Autosomal dominant osteopetrosis (ADO) is a sclerotic bone disorder due to failure of osteoclasts. ADO poses difficulties during arthroplasty because of the increased chance for iatrogenic fractures due to sclerotic bone. ADO is divided into two types based on radiological findings, fracture risk, and osteoclast activity. These differences suggest less brittle bone in patients with ADO I compared to that of patients with ADO II, which suggests a smaller chance of preoperative fractures during cementless arthroplasty in ADO I compared with that in ADO II. A case of cementless total knee arthroplasty in a patient with ADO I is presented. Total hip arthroplasty was performed during follow-up, and known major problems related to ADO II were experienced. Therefore, the differences between ADO I and ADO II may not be clinically relevant for an iatrogenic fracture during arthroplasty in patients with ADO.

Show MeSH
Related in: MedlinePlus