Total knee arthroplasty in osteogenesis imperfecta

Challenges of total knee arthroplasty in osteogenesis imperfecta: case report and literature review

The majority of adults with mild osteogenesis imperfecta report significant functional impairment due to musculoskeletal concerns. Knee osteoarthritis is common in these patients. Although total knee arthroplasty has become a highly efficient surgical technique for osteoarthritis, this procedure remains uncommon in patients with osteogenesis imperfecta. This current case report describes the important clinical aspects of osteogenesis imperfecta that must be considered during the planning and performance of a total knee replacement. A 62-year-old female patient with a history of osteogenesis imperfecta suffered from severe osteoarthritis of the knee with valgus deformity. Two years after posterior stabilized total knee arthroplasty, her Hospital for Special Surgery knee score had improved from preoperative 53 points to 85 points at the final follow-up. The current case report describes the crucial technical aspects of a successful total knee replacement in this uncommon scenario. Underlying deformities and concomitant pathologies constitute specific surgical challenges. Special care should be taken to protect the patient from potential complications.

Three-Dimensional Printing and Computer Navigation for Correction of Multiple Deformities in Osteogenesis Imperfecta: A Case Report

CASE

A 44-year-old man with osteogenesis imperfecta presented with multiple debilitating musculoskeletal deformities. Bi-level osteotomies, assisted by 3-dimensional (3D)-printed patient-specific cutting guides, were performed to correct extraarticular valgus and procurvatum tibial deformities. Concomitant computer-navigated total knee arthroplasty was performed to restore neutral mechanical alignment. Postoperative x-ray showed good correction of deformities, and 1 year postoperatively, the patient is able to walk unaided with significant resolution of knee pain.

CONCLUSION

3D-printed osteotomy guides and computer navigation can be instrumental in procedures requiring a high degree of precision. With sufficient training, modern orthopaedic technologies can be implemented by surgeons themselves and combined to facilitate precise and personalized management of challenging conditions.

Total knee replacement in Osteogenesis Imperfecta: a case report and review of the literature

BACKGROUND

A review of the literature revealed that only 9 total knee replacements were performed on patients with osteogenesis imperfecta (OI), with one being a revision procedure of a periprosthetic fracture. Of the 9 primary procedures, all used cemented prostheses, and 3 patients had an osteotomy at the same procedure. Our patient required a hinged prosthesis because of collateral ligament incompetence and is the first such case reported in the literature.

CASE PRESENTATION

Presented here is a total knee replacement performed on a 52-year-old patient with osteogenesis imperfecta (OI) who injured her left knee and ruptured her anterior cruciate ligament. Her right knee suffered from severe degenerative changes with an incompetent medial collateral ligament. It was decided to replace the right knee before addressing the left knee injury. A hinged revision prosthesis was used. The smallest components available were used because of the small anatomical bony dimensions.

CONCLUSION

This is the first reported case of a hinged prosthesis and highlights the soft tissue component of osteogenesis imperfecta. We also highlight the technical problems with these patients, including mal-alignment, small bony dimensions and bone fragility.