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Soundarrajan D, Singh R, Rajkumar N, Dhanasekararaja P, Rajasekaran S. Clinical outcomes of primary total knee arthroplasty in non-syphilitic neuroarthropathy of the knee. INTERNATIONAL ORTHOPAEDICS 2024; 48:2603-2608. [PMID: 38967647 DOI: 10.1007/s00264-024-06244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Total knee arthroplasty (TKA) in syphilitic neuroarthropathy using earlier implant designs was associated with poorer outcomes. Literature on TKA for non-syphilitic neuroarthropathy using modern contemporary prosthesis is scarce. We aim to analyse the clinical and radiological outcomes of TKA in neuropathic joints. METHODS A final cohort of 17 patients (21 knees) with the diagnosis of neuropathic joint undergoing primary TKA between January 2013 to January 2019 were included in the study. The preoperative ambulatory status, range of motion, type of prosthesis, level of constraint and any augmentation used were retrieved from medical records. Radiological evaluation includes Koshino's staging, the magnitude of deformity defined by the Hip-Knee-Ankle (HKA) angle, and any progressive loosening. Pre and postoperative functional scores were obtained by the Knee Society (KSS) and Knee Society Functional Score (KSS-F). Any complications or reoperation were noted till the final follow-up. Preoperative and follow-up functional scores, HKA and range of motion were compared using the paired Samples test. RESULTS The mean follow-up was 40.2 months (range, 15 to 75 months). Preoperatively, according to the Koshino staging, five knees were in stage 3 (23.8%). The mean HKA angle in valgus knees was 23.60 (range, 11.10 to 42.50) and for the varus knees was 19.30 (range, 4.90 to 39.60). The prosthesis used were posterior stabilized in 7 knees (33.3%), varus-valgus constrained in five knees (23.8%) and a rotating hinge was required in nine knees (42.8%). Metaphyseal sleeves were used along with hinge prosthesis in six knees (28.6%). The mean arc of motion improved from 102.4 ± 22.7 degrees to 105.7 ± 15.5 degrees postoperatively (p = 0.27). The knee society and knee society functional scores improved from 23.3 ± 9.3 and 28.3 ± 12.2 preoperatively to 81.1 ± 5.4 and 80.4 ± 8.5 during the follow up respectively (p < 0.001). There were no progressive radiolucent lines in any knees at the final follow-up. One patient had intraoperative bony medial collateral ligament injury, one patient had deep vein thrombosis after five days from the index surgery and another had postoperative periprosthetic tibial shaft fracture. CONCLUSION According to our study, the clinical outcomes of TKA for neuroarthropathy show significant improvement with the diagnosis of non-syphilitic neuroarthropathy, utilization of modern constrained prostheses, and early rehabilitation, at medium-term follow-up. Tibial and femoral stems are preferred for equal stress distribution and to prevent early loosening.
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Affiliation(s)
| | - Rithika Singh
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
| | - Natesan Rajkumar
- Department of Orthopaedics, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641 043, India
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Ehara Y, Nakano N, Takayama K, Kuroda Y, Hashimoto S, Hayashi S, Matsushita T, Niikura T, Kuroda R, Matsumoto T. Rotating Hinge Knee Arthroplasty for Charcot Joints of the Knees in Patients With Charcot-Marie-Tooth Disease: A Report of Two Cases. Cureus 2024; 16:e63154. [PMID: 39070426 PMCID: PMC11272421 DOI: 10.7759/cureus.63154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
We report two cases wherein rotating hinge knee (RHK) arthroplasty was performed for Charcot joints that developed secondary to Charcot-Marie-Tooth disease (CMT). Case 1 was of a 74-year-old woman with CMT. She presented with muscle weakness and sensory disturbances of the distal lower limbs, deformity, and significant medial instability of the bilateral knees. She was then diagnosed with Charcot joints of the knees secondary to CMT, which were treated with RHK arthroplasty. Five years postoperatively, there was no instability, and she was able to stand unassisted without pain. Case 2 was a 90-year-old woman with CMT who presented with muscle weakness and sensory disturbances of the distal lower limbs, deformity, and significant medial instability of the bilateral knees. She was then diagnosed with Charcot joints of the knees secondary to CMT, which were also treated with RHK arthroplasty. One year postoperatively, there was no instability, and she was able to walk smoothly using a walker. These clinical cases indicate that RHK arthroplasty can be a good therapeutic option for Charcot joints of the knees in patients with CMT.
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Affiliation(s)
- Yutaka Ehara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
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Luo Z, Ding X, Yuan Y, Hou L. Rare complication of rheumatoid arthritis: Charcot Neuro-osteoarthropathy. BMC Musculoskelet Disord 2024; 25:340. [PMID: 38685038 PMCID: PMC11057095 DOI: 10.1186/s12891-024-07424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disease.However, there are few cases of Charcot Neuro-osteoarthropathy (CN) caused by rheumatoid diseases in clinical reports. It is not easy to pay attention to the diagnosis of CN in the complications of rheumatoid disease, which greatly increases the probability of misdiagnosis and missed diagnosis. This case reported a rare complication of rheumatoid arthritis, Charcot arthritis, and the molecular mechanism and diagnosis and treatment of CN caused by RA were systematically discussed. CASE PRESENTATION The patient, a 79-year-old woman, was hospitalized due to bilateral shoulder pain, limited activity for half a year, aggravated for 4 months to the hospital. During this period, the symptoms did not improve after treatment with acupuncture and Chinese medicine. The patient was previously diagnosed with rheumatoid arthritis for more than 3 years and intermittent irregular use of methylprednisolone and methotrexate for 2 years. She had a history of osteoporosis. PHYSICAL EXAMINATION symmetrical malformed swelling of the finger joints of both hands; Bilateral supraspinatus and deltoid muscle atrophy, tenderness at the acromion, and attachment of the long head tendon of the biceps brachii were observed. The left Dugas test and the right Dugas test were positive.Blood test: anti-cyclic citrullinated peptide antibody (A-CCP) 33.10U/ml (normal range: 0-5RU/ml); antinuclear antibody quantification (ANA) 47.40AU/ml (normal range: Negative or < 32); anti-double stranded DNA IgG antibody quantification (dsDNA) 31.00 IU/ml (normal range: 0-100 IU/ml); D-Dimer 6.43 µg/ml (normal range: 0-0.5 mg/L); erythrocyte sedimentation rate (ESR) was 27 mm/h (normal range: < 20 mm/60 min). C-reactive protein (CRP) 39.06 mg/L(0.068-8 mg/L).MRI 3.0 T enhancement of bilateral shoulder joints, cervical spine and thoracic spine showed: 1.Large bone destruction, cartilage injury, multiple effusion, synovitis, obvious on the right side. 2.Intervertebral disc degeneration, cervical 3/4, 4/5, 5/6, 6/7 disc herniation, with cervical 3/4 obvious, posterior central herniation; CONCLUSIONS: Rheumatoid arthritis complicated with Charcot's joint is rare. Clinically, patients with rheumatoid diseases should not ignore Charcot's joint complications because of rareness. Early blood inflammatory markers, neuro electrophysiology, and imaging MRI of rheumatoid CN are of great significance for the diagnosis of this mild or early neurovascular inflammation. Early diagnosis and treatment are helpful to prevent further joint injury. The clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed.
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Affiliation(s)
- Zhiyuan Luo
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Xinxiang Ding
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Yu Yuan
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
| | - Lei Hou
- The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China.
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Onoi Y, Matsumoto T, Nakano N, Tsubosaka M, Kamenaga T, Kuroda Y, Ishida K, Hayashi S, Kuroda R. Mid- to Long-Term Results of Total Knee Arthroplasty for Charcot Arthropathy of the Knee. Indian J Orthop 2024; 58:308-315. [PMID: 38425826 PMCID: PMC10899143 DOI: 10.1007/s43465-023-01094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024]
Abstract
Background Total knee arthroplasty (TKA) for Charcot arthropathy of the knee is considered controversial because of its higher complication rate compared with that of TKA for osteoarthritis. In this study, we investigated the clinical outcomes, survival rates, and complications of primary TKA for Charcot arthropathy. Methods We conducted a retrospective analysis of nine patients (12 knees) with Charcot arthropathy who underwent TKA. The mean age of the patients was 63.9 ± 9.4 years (range, 52-83 years). The most frequent causative disease was diabetes mellitus (three patients). Patients' clinical outcomes, including the 2011 Knee Society Score and the range of motion, were compared between preoperative and the most recent postoperative data. The 5- and 10-year survival rates for aseptic revision, revision due to infection, and complications were examined. The mean follow-up period was 7.3 ± 3.9 years (range, 3-14 years). Results The 2011 Knee Society Score and the knee flexion angle significantly improved after TKA surgery (P < 0.05). The 5-year survival rates for aseptic revision, revision due to infection, and complications were 100%, 91.7%, and 83.3%, respectively; the 10-year survival rates for these parameters were the same. One patient underwent revision for insert replacement due to periprosthetic infection, and the other patient had varus/valgus instability due to soft tissue loosening. Conclusions The mid- to long-term results of TKA for Charcot arthropathy were generally favorable. Our findings indicate that TKA may be a viable treatment option for Charcot arthropathy.
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Affiliation(s)
- Yuma Onoi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Kii S, Sonohata M, Mawatari M. Total knee arthroplasty for neuropathic arthropathy in a patient with leprosy. Mod Rheumatol Case Rep 2023; 8:219-223. [PMID: 37862242 DOI: 10.1093/mrcr/rxad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
Patients with leprosy are known to tend to develop neuropathic arthropathy, known as Charcot joint. There are no case reports of total knee arthroplasty (TKA) in patients with leprosy with polyarticular neuropathic arthropathy, and the results are unknown. In this study, we report a case of TKA in a patient with leprosy with polyarticular neuropathic arthropathy and discuss its outcomes and indications. Right TKA using the NexGen Legacy Constrained Condylar Knee implant was performed in a 62-year-old man with neuropathic arthropathy in multiple joints with clinical symptoms, particularly in the right knee. Seven years post-operation, the American Knee Society Score-knee and -function, which represent knee function and activities of daily living on a scale of 100 points, were significantly improved compared with preoperative values, from 30 to 99 points and 0 to 60 points, respectively. Indications for arthroplasty for neuropathic arthropathy should be carefully considered in each individual case. In this case, the patient had neuropathic arthropathy in multiple joints; however, TKA was performed because recovery of function in the right knee was expected to significantly improve the patient's activities of daily living, and a good mid-term clinical outcome was achieved. Therefore, indications for arthroplasty should be considered in patients with systemic neuropathic arthropathy such as leprosy, and with accurate assessment and appropriate implant selection, good long-term outcomes may be expected.
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Affiliation(s)
- Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Saga Central Hospital, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. J Arthroplasty 2023; 38:2193-2201. [PMID: 37778918 DOI: 10.1016/j.arth.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). METHODS We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. RESULTS The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. CONCLUSION This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.
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Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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7
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Rheumatol 2023; 75:1877-1888. [PMID: 37746897 DOI: 10.1002/art.42630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). METHODS We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. RESULTS The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. CONCLUSION This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.
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Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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8
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Hannon CP, Goodman SM, Austin MS, Yates A, Guyatt G, Aggarwal VK, Baker JF, Bass P, Bekele DI, Dass D, Ghomrawi HMK, Jevsevar DS, Kwoh CK, Lajam CM, Meng CF, Moreland LW, Suleiman LI, Wolfstadt J, Bartosiak K, Bedard NA, Blevins JL, Cohen-Rosenblum A, Courtney PM, Fernandez-Ruiz R, Gausden EB, Ghosh N, King LK, Meara AS, Mehta B, Mirza R, Rana AJ, Sullivan N, Turgunbaev M, Wysham KD, Yip K, Yue L, Zywiel MG, Russell L, Turner AS, Singh JA. 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Care Res (Hoboken) 2023; 75:2227-2238. [PMID: 37743767 DOI: 10.1002/acr.25175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA). METHODS We developed 13 clinically relevant population, intervention, comparator, outcomes (PICO) questions. After a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence (high, moderate, low, or very low), and evidence tables were created. A Voting Panel, including 13 physicians and patients, discussed the PICO questions until consensus was achieved on the direction (for/against) and strength (strong/conditional) of the recommendations. RESULTS The panel conditionally recommended against delaying TJA to pursue additional nonoperative treatment including physical therapy, nonsteroidal antiinflammatory drugs, ambulatory aids, and intraarticular injections. It conditionally recommended delaying TJA for nicotine reduction or cessation. The panel conditionally recommended delay for better glycemic control for patients who have diabetes mellitus, although no specific measure or level was identified. There was consensus that obesity by itself was not a reason for delay, but that weight loss should be strongly encouraged, and the increase in operative risk should be discussed. The panel conditionally recommended against delay in patients who have severe deformity or bone loss, or in patients who have a neuropathic joint. Evidence for all recommendations was graded as low or very low quality. CONCLUSION This guideline provides evidence-based recommendations regarding the optimal timing of TJA in patients who have symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy was ineffective to improve patient-important outcomes, including pain, function, infection, hospitalization, and death at 1 year. We acknowledge that the evidence is of low quality primarily due to indirectness and hope future research will allow for further refinement of the recommendations.
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Affiliation(s)
| | - Susan M Goodman
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | | | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson
| | | | - Charis F Meng
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | - Linda I Suleiman
- Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Jesse Wolfstadt
- Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jason L Blevins
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | | | | | - Nilasha Ghosh
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | | | | | - Bella Mehta
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Reza Mirza
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Katherine D Wysham
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle
| | - Kevin Yip
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Linda Yue
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Linda Russell
- Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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9
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Mei F, Li JJ, Lin J, Zhou D, Xing D. Constrained Condylar Prostheses for the Treatment of Charcot Arthropathy: A Case Report and Literature Review. Orthop Surg 2023; 15:1423-1430. [PMID: 36859755 PMCID: PMC10157705 DOI: 10.1111/os.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Neuroarthropathy of the knee or Charcot knee, leading to chronic joint destruction, is a rare disease that is difficult to diagnose. The treatment of this condition is difficult and controversial. CASE PRESENTATION A 74-year-old Asian woman has had bilateral knee pain for 22 years and deformity for 10 years, which has been aggravating for 2 months. Physical examination showed bilateral knee varus deformity greater than 15°, and -20 to 90° range of motion. X-ray revealed bilateral varus deformity with massive free body hyperplasia. Combined with medical history as syringomyelia, the patient was diagnosed with bilateral Charcot knees and bilateral joint replacements were performed using Legacy Constrained Condylar Knee prostheses (LCCK; Zimmer, USA). The patient reported satisfactory treatment outcomes, pain relief, and improved range of motion in both knees, without postoperative complications or prosthesis loosening at 2 year after operation. CONCLUSIONS Total knee arthroplasty (TKA) may be considered a viable option for treating the Charcot knee. The use of constrained condylar prostheses can produce satisfactory results. Attention should be given to survival risks, complications, and other potential determining factors associated with TKA when devising a treatment strategy for the Charcot knee.
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Affiliation(s)
- Fengyao Mei
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Sydney, Australia
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Diange Zhou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Dan Xing
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
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10
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Nakamura H, Iwamoto T, Kimura H, Suzuki T, Matsumura N, Matsumoto M, Nakamura M. A case of neuropathic arthropathy of the elbow with early loosening after total elbow arthroplasty. Mod Rheumatol Case Rep 2022:rxac094. [PMID: 36478255 DOI: 10.1093/mrcr/rxac094] [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: 09/12/2022] [Revised: 10/28/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
We reported the case of a 65-year-old woman who presented with neuropathic arthropathy of the elbow and had undergone cervical spinal cord tumour resection at 32 years of age. Open synovectomy with free-body resection was performed; however, the instability of the elbow joint rapidly progressed. Therefore, we performed total elbow arthroplasty using a linked-type prosthesis. However, the humeral stem severely loosened 1 year after arthroplasty. Further, a peri-prosthetic humeral fracture developed due to a minor trauma. Revision total elbow arthroplasty using a long-stem prosthesis was performed 4 years after the primary total elbow arthroplasty. Radiographs taken 2 years after the revision surgery showed no evidence of implant loosening. In this case, early post-operative loosening occurred despite the use of a linked-type prosthesis and an appropriate cementing technique, suggesting that normal implants may not provide sufficient fixation for neuropathic arthropathy of the elbow. Since surgery for neuropathic arthropathy generally has a poor prognosis, surgical interventions including total elbow arthroplasty should be carefully considered.
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Affiliation(s)
- Hiroshi Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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11
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Hua L, Lei P, Hu Y. Knee Reconstruction Using 3D-Printed Porous Tantalum Augment in the Treatment of Charcot Joint. Orthop Surg 2022; 14:3125-3128. [PMID: 36056528 DOI: 10.1111/os.13484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Charcot joint disease is a rare neurogenic lesion of the joint characterized by progressive joint destruction with dislocation or subluxation. However, whether a joint replacement should be performed for severe joint damage is controversial. CASE PRESENTATION This paper reports a case of severe Charcot joint disease with a large bone defect that was treated with arthroplasty assisted by a customized 3D-printed porous tantalum. The patient was admitted to the hospital with a 9-year history of bilateral knee pain that had aggravated in the past 2 months. Radiography showed osteogeny and sclerosis in both knees, free bone fragments, heterotopic ossification, new bone, and osteophyte formation, irregular margins, apparent narrowing of joint space, and severe joint damage (Anderson Orthopedic Research Institute classification type III). Based on the present illness, history, imaging, and laboratory examination, Charcot joint disease was confirmed. Conservative treatment has been reported in the literature. There are limited reports on the surgical treatment of severe Charcot joint disease. We followed up with the patient for a year after the operation, and the imaging and clinical evaluation results were good. Postoperative X-ray examinations showed good alignment of force lines, good joint space, and no evidence of loosening. The patient was mobile and did not need crutches. CONCLUSIONS Through accurate surgical evaluation and preparation of 3D-printed porous tantalum implants, severe AORI classification type III Charcot joint disease can effectively restore the range of motion of the knee joint, the lower limb alignment, and finally achieve good functional results of walking without crutches.
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Affiliation(s)
- Long Hua
- Department of Orthopaedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, P. R. China.,Department of Orthopaedics, Xiangya Hospital Central South University, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Changsha, P. R. China.,Department of Orthopaedics, The Sixth Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Pengfei Lei
- Department of Orthopaedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, P. R. China.,Department of Orthopaedics, Xiangya Hospital Central South University, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Changsha, P. R. China
| | - Yihe Hu
- Department of Orthopaedics, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, P. R. China.,Department of Orthopaedics, Xiangya Hospital Central South University, Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Changsha, P. R. China
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12
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Neuropathic (Charcot) Arthropathy of the Knee. J Am Acad Orthop Surg 2021; 29:e1159-e1166. [PMID: 34437307 DOI: 10.5435/jaaos-d-21-00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/05/2021] [Indexed: 02/01/2023] Open
Abstract
Neuropathic arthropathy of the knee (Charcot knee) is a rare pathology defined by progressive destruction of bone and soft tissue in a patient with underlying peripheral neuropathy. Historically, Charcot knee was associated with neurosyphilis, but it has been increasingly described as a late stage of diabetes. The pathophysiology of the disease is not completely understood, but theories include repetitive microtrauma and an abnormal neurovascular response. Patients present with a warm, swollen, and unstable joint and have rapid bone resorption and characteristic findings on pathology. Nonsurgical options for pain and dysfunction include total contact casting and bracing treatment. Pharmacologic management includes diphosphonates, although this use is considered off-label. Surgical management historically included knee fusion. However, recent case series have suggested that newer prostheses allow for successful arthroplasty in this cohort, although complications are higher when compared with joint arthroplasty in patients with normal neurologic function.
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13
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Du W, Dai R, Chen R, Shen F. Rotation-hinged knee prosthesis for the treatment of Charcot arthropathy: a case report and literature review. J Int Med Res 2021; 49:3000605211058871. [PMID: 34812073 PMCID: PMC8649473 DOI: 10.1177/03000605211058871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Charcot arthropathy is a type of destructive osteoarthropathy characterized by
neurotrophic and sensory disorders. The condition is relatively rare, with an
insidious onset, and it is easily misdiagnosed. Total knee arthroplasty (TKA)
can cause excessive joint wear, continuous inflammatory stimulation of the
prosthesis, postoperative residual cavity, prosthesis loosening and subsidence,
peripheral fracture, infection, and other complications. Furthermore, these
complications are more likely to occur in patients with Charcot arthropathy
because of disease-specific pathological characteristics, when TKA is performed.
Therefore, Charcot arthropathy was once a contraindication to TKA. Recently,
with the optimization of joint prostheses and the maturity of surgical
techniques, more studies have reported successful cases of TKA in patients with
Charcot arthropathy. We report a case of Charcot arthropathy in our hospital,
and describe the patient’s medical history, clinical symptoms, signs, imaging
findings, diagnosis, and the entire TKA process, to explore the TKA strategy and
prosthesis selection in a patient with Charcot arthropathy.
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Affiliation(s)
- Weibin Du
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Rongdan Dai
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Rongliang Chen
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Fuxiang Shen
- Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou, China
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14
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Lu V, Zhang J, Thahir A, Zhou A, Krkovic M. Charcot knee - presentation, diagnosis, management - a scoping review. Clin Rheumatol 2021; 40:4445-4456. [PMID: 34031760 PMCID: PMC8143744 DOI: 10.1007/s10067-021-05775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Charcot arthropathy is a progressive, non-infectious, destructive inflammatory process. Charcot arthropathy of the knee (CK) is rare and diagnosis is often delayed, resulting in detrimental outcomes. This scoping review aims to investigate the literature on CK, present the pathognomonic features of CK to aid early diagnosis, and suggest gaps in the literature for future research. METHODS A systematic search of PubMed, EMBASE, Web of Science for literature relevant to CK was performed. Primary studies such as case reports, case series, retrospective studies were included. Review articles and animal studies were excluded. RESULTS Of the 513 results, 58 were included in qualitative synthesis. Average time from symptom onset to CK diagnosis was 50.5 months. Eighteen and twenty-one studies included patients who had diabetes mellitus and syphilis, respectively. Twenty-one studies reported pain as a presenting complaint, but the degree of pain didn't correspond with the level of destruction. Oedema and joint effusion were noticed in 34 studies. Twenty-nine studies reported lower limb hypoesthesia and 17 studies reported decreased tendon reflex. Twenty-eight studies reported initial conservative treatment, often in a knee brace with minimal weight bearing, 9 of which needed subsequent surgical management. Twelve studies utilised arthrodesis, with fracture at the intramedullary nail entry site being the most common complication. Twenty-four studies utilised TKA. CONCLUSION The literature on CK remains sparse, with most publications being case reports. Given that CK dramatically reduces quality of life, increases morbidity of patients, there is need for more literature on evidence-based options for early diagnoses and management.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
- Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK.
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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15
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Rattanaprichavej P, Towiwat P, Laoruengthana A, Dilokthornsakul P, Chaiyakunapruk N. Mid- to long-term outcomes of contemporary total knee arthroplasty in Charcot neuroarthropathy: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:556-564. [PMID: 34377547 PMCID: PMC8335961 DOI: 10.1302/2058-5241.6.200103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Total knee arthroplasty (TKA) is an effective procedure to treat many patients with end-stage knee arthropathy. However, the extension of TKA for patients with Charcot neuroarthropathy (CNA) is controversial, with relatively limited evidence defining optimal reconstruction techniques.This systematic review of relevant studies that were published from January 2000 to June 2020 aimed to define survivorship, complications, reoperation, and component revision rates of contemporary TKA performed for CNA.We identified 127 TKA performed for CNA in five studies that comprised ≥ 7 knees with ≥ 5 years of follow-up.Overall implant survivorship was 85.4%. The overall complication rate was 26.4%, with the most common complications including instability (24.0%), periprosthetic fracture (17.4%), infection (13.0%), ligament injury (10.9%) and aseptic loosening (10.9%).The aetiology of CNA and prosthesis type had no influence on clinical outcomes, whereas the effect of staging of disease and ataxia status was still inconclusive.Understanding the potential determinants, survivorship and risk of complications related to TKA performed in CNA may help surgeons to deal with patient expectations. Cite this article: EFORT Open Rev 2021;6:556-564. DOI: 10.1302/2058-5241.6.200103.
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Affiliation(s)
- Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Patapong Towiwat
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA.,School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
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16
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Bilateral Primary Total Knee Arthroplasty and Reconstruction of the Medial Tibial Plateau by an Asymmetric Cone in a Patient with Charcot Arthropathy. Case Rep Surg 2021; 2021:9965640. [PMID: 34211796 PMCID: PMC8205600 DOI: 10.1155/2021/9965640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/02/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022] Open
Abstract
Charcot arthropathy of the knee is an extremely rare orthopedic disease that is very challenging for the treating physician and is associated with many complications, especially if it is occurring on both knees. Meanwhile, in the advanced stage, despite many potential complications, TKA is recognized as the gold standard. However, destruction of the medial tibial plateau is typical for the disease, which makes a stable anchorage of the prosthesis much more difficult. Therefore, we present a case in which sufficient primary stability could be achieved with an asymmetrical second-generation tibial cone with an anatomical design and implantation instruments adapted to the bony anatomy in the presence of severe tibial destruction on both sides. In the two-year follow-up, the patient showed good mobility and stability on both sides. In advanced Charcot arthropathy of the knee, the use of asymmetric tibial cones appears to be an appropriate solution for secure fixation and stability of the implant.
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17
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Total Knee Arthroplasty With Megaprosthesis for Idiopathic Charcot Knee. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00011. [PMID: 33986223 DOI: 10.5435/jaaosglobal-d-20-00158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/22/2021] [Indexed: 01/23/2023]
Abstract
Charcot knee is a rare condition with few reported cases in the literature. Although the clinical presentation is highly variable, Charcot knee classically presents with painful arthropathy in addition to instability and decreased range of motion. Herein, we describe the case of a 72-year-old man with idiopathic Charcot knee. The diagnosis was established on the basis of history of neuropathic arthropathy of the knee, supported by knee radiographs and the exclusion of all known etiologies of Charcot knee. Because of a highly destructed knee joint, the patient underwent a total knee arthroplasty using the Global Modular Replacement System proximal tibial prosthesis. The surgery was done without any major complications, resulting in symptomatic and functional improvements.
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18
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A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations. J Arthroplasty 2020; 35:3383-3392. [PMID: 32873450 DOI: 10.1016/j.arth.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODS We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTS In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSION TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
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19
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Yang QH, Hsu P, Gao YS, Zhang CQ. Charcot neuroarthropathy of the knee due to idiopathic sensory peripheral neuropathy. BMC Musculoskelet Disord 2019; 20:501. [PMID: 31666060 PMCID: PMC6822451 DOI: 10.1186/s12891-019-2873-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022] Open
Abstract
Background Charcot neuroarthropathy is a systemic disease that generates pathological changes in the musculoskeletal system, causing instability, dislocations, and deformities. Charcot neuroarthropathy of the knee, due to either diabetes mellitus or syringomyelia, is anecdotally reported with the epidemic of the diseases. However, idiopathic sensory peripheral neuropathy can inflict osteoarticular structures directly, inducing a dysfunctional Charcot neuroarthropathy. An early diagnosis and effective relief of the symptomatic deformity is essential for the treatment. Case presentation We report the case of a patient with idiopathic sensory peripheral neuropathy who presented with a swelling right knee, as well as distorted and painless gait disorder, diagnosed as Charcot neuroarthropathy of the knee. Partial weight bearing with a hinged knee brace was used to correct the abnormal alignment and gait posture, and bisphosphonates were prescribed to decrease pathological bone resorption. Although the alignment and Knee Society Score got a gradual deterioration, the combination of orthosis and pharmacy could alleviate the symptom to a certain extent. Conclusion The diagnosis of Charcot neuroarthropathy of the knee is rare that requiring early diagnosis. The presence of features, including painlessness, numbness, and deformed arthropathy following chronic-onset algesthesia loss should be taken carefully.
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Affiliation(s)
- Qian-Hao Yang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Peichun Hsu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. .,Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, WA, 6009, Australia.
| | - Chang-Qing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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