1
|
Savin L, Pinteala T, Botez P, Miu S, Forna N, Mihailescu D, Popescu DC, Enescu G, Sirbu PD. Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review. J Pers Med 2023; 13:1705. [PMID: 38138932 PMCID: PMC10745000 DOI: 10.3390/jpm13121705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.
Collapse
Affiliation(s)
- Liliana Savin
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Tudor Pinteala
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Paul Botez
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Smaranda Miu
- Department of Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Norin Forna
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Dan Mihailescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Dragos Cristian Popescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Sf. Spiridon’ County Emergency Hospital, 700661 Iasi, Romania
| | - George Enescu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| | - Paul Dan Sirbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.S.); (N.F.); (D.M.); (D.C.P.); (G.E.); (P.D.S.)
- Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania;
| |
Collapse
|
2
|
Konarski W, Poboży T, Hordowicz M. Hip fusion takedown with total knee and hip arthroplasty in a patient with end-stage chronic kidney disease - a case report and narrative literature review. Orthop Rev (Pavia) 2022; 14:35452. [PMID: 35769648 PMCID: PMC9235434 DOI: 10.52965/001c.35452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/29/2022] [Indexed: 08/12/2023] Open
Abstract
Hip fusion takedown and conversion to [total hip replacement (THR)] is a technically demanding procedure related to a high risk of complications, however, in selected patients, it might be required before performing [total knee arthroplasty (TKA)]. Currently, there is no standard of care, and each case has to be considered individually. We describe a case of a 70-year-old male with left hip ankylosis and debilitating pain in the ipsilateral knee. We describe the justification and technical issues related to the management of this case, and the difficulties associated with performing those in a dialyzed patient. Based on our experience and available literature, we conclude that the patient has to be informed of possible complications and outcomes. Even the presence of serious comorbidity does not necessarily preclude such a procedure if the patient is in good condition and the successful outcome is highly probable.
Collapse
Affiliation(s)
| | - Tomasz Poboży
- Department of Orthopedic Surgery, Ciechanów Hospital
| | | |
Collapse
|
3
|
Encinas-Ullán CA, Gómez-Cardero P, Rodríguez-Merchán EC. Total Knee Arthroplasty in Patients With Prior Ipsilateral Hip Fusion: A Surgical Technique. HSS J 2022; 18:175-181. [PMID: 35087349 PMCID: PMC8753539 DOI: 10.1177/15563316211039203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In patients with severe osteoarthritis of the knee with prior ipsilateral hip fusion who require total knee arthroplasty (TKA), a controversial issue is whether to first convert the hip fusion to a total hip arthroplasty (THA) or to perform TKA without reconstruction of the hip. Also, immobility of the ipsilateral, fused hip adds significant technical challenge because the usual positioning of the leg requires modification in order to gain access needed for the TKA. TECHNIQUE In such cases, we position the patient with the knee suspended, similar to how we perform knee arthroscopy. In our experience, the ipsilateral knee has significant deformity and is best addressed with a constrained, hinged TKA. RESULTS In 3 patients with severe knee osteoarthritis with prior ipsilateral hip fusion-a 72-year-old man and a 79-year-old woman with hip arthrodesis due to posttraumatic arthritis and an 81-year-old woman with hip arthrodesis due to congenital dislocation of the hip-rotating-hinge knee prostheses were implanted due to severe knee instability. All 3 patients had satisfactory results, without complications, after follow-up of 1 to 5 years. CONCLUSIONS We obtained satisfactory results in the short and medium term without previously converting the hip arthrodesis to THA by positioning patients with the knee suspended, in a way similar to when knee arthroscopy is performed, and implanting rotating hinge TKAs due to severe preoperative knee instability.
Collapse
Affiliation(s)
| | | | - E. Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain,E. Carlos Rodríguez-Merchán, MD, PhD, Department of Orthopedic Surgery, La Paz University Hospital, Paseo de la Castellana 261, Madrid 28046, Spain.
| |
Collapse
|
4
|
Samborski SA, Quinzi D, Balkissoon R. Total Knee Arthroplasty with Prior Ipsilateral Hip Arthrodesis. Arthroplast Today 2020; 6:830-834. [PMID: 33020735 PMCID: PMC7527288 DOI: 10.1016/j.artd.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 11/15/2022] Open
Abstract
Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature. Traditionally, TKA is performed supine, with the aid of knee-positioning devices allowing for hip flexion and range of motion of the knee to facilitate ease of surgical intervention. However, TKA using traditional positioning would not be possible in the presence of ipsilateral hip arthrodesis preventing hip motion. This case report describes a TKA performed for a 72-year-old woman with end-stage osteoarthritis of the right knee, ipsilateral hip arthrodesis, and leg-length discrepancy as the sequelae of slipped capital femoral epiphysis. We describe novel surgical positioning to be used to facilitate TKA in the absence of ipsilateral hip motion with bed modifications and the use of an extremity positioning device.
Collapse
Affiliation(s)
- S Andrew Samborski
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
| | - David Quinzi
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
| | - Rishi Balkissoon
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|