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Reading L, Brown C, Pasqualini I, Huffman N, Piuzzi NS. 24-Year-Old Patient with Klippel-Trenaunay Syndrome Underwent Cementless Robotic Cruciate-Retaining TKA: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00008. [PMID: 38608129 DOI: 10.2106/jbjs.cc.23.00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
CASE A 24-year-old man with Klippel-Trenaunay syndrome (KTS) presented with severe knee osteoarthritis unresponsive to conservative measures. Owing to end-stage, debilitating arthritic symptoms, surgery was pursued. Careful preoperative, multidisciplinary planning/treatment included magnetic resonance imaging to characterize the venous malformations throughout the right lower extremity, preoperative sclerotherapy, sirolimus, and robotic-assisted cementless total knee arthroplasty (TKA). CONCLUSION Cementless robotic-assisted TKA with selective patellar resurfacing can be a viable option for young KTS patients with severe osteoarthritis when a meticulous multidisciplinary approach, including sclerotherapy and advanced imaging, is undertaken to analyze vascular abnormalities, minimize surgical risks, preserve bone stock, and optimize outcomes.
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Affiliation(s)
- Landon Reading
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Colin Brown
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | | | - Nickelas Huffman
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Morrison TA, Streufert BD, Engel CC, Bernasek TL, Gill M. Complex Total Hip Arthroplasty in a Patient with Klippel-Trénaunay Syndrome: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00007. [PMID: 35020676 DOI: 10.2106/jbjs.cc.20.00488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Klippel-Trénaunay syndrome (KTS) carries manifestations including skeletal dysplasia and prominent vascular malformations. This report details a case of hip dysplasia in the setting of KTS treated with total hip arthroplasty (THA) requiring preoperative embolization, intraoperative angiography for placement of an iliac artery occlusive balloon, and modular hip arthroplasty components for femoral and acetabular dysplasia. Perioperatively, the patient rehabilitated well and was walking painlessly and unassisted at 3 and 12 months postoperatively. CONCLUSION Successful THA for dysplasia and degenerative changes associated with KTS is possible but requires a complex multidisciplinary perioperative approach.
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Affiliation(s)
- Todd A Morrison
- Florida Orthopaedic Institute, Adult Reconstruction, Temple Terrace, Florida
| | - Benjamin D Streufert
- Department of Orthopaedics, University of South Florida College of Medicine, Tampa, Florida
| | - Corey C Engel
- Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Thomas L Bernasek
- Florida Orthopaedic Institute, Adult Reconstruction, Temple Terrace, Florida.,Department of Orthopaedics, University of South Florida College of Medicine, Tampa, Florida
| | - Meera Gill
- Foundation for Orthopaedic Research and Education, Tampa, Florida
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Wang X, Zhang K, Yuan L, Sun B, Yang B. Knee Arthroplasty in Klippel-Trénaunay Syndrome with 3-Dimensional-Printed Patient-Specific Instruments: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00016. [PMID: 34242206 DOI: 10.2106/jbjs.cc.20.00922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CASE Using a multidisciplinary team approach, a cemented posterior-stabilized total knee arthroplasty was performed using 3-dimensional-printed patient-specific instruments (PSI) in a 34-year-old man with symptomatic end-stage knee osteoarthritis secondary to Klippel-Trénaunay syndrome (KTS). At 1-year follow-up, the patient was able to walk without pain and return to work. CONCLUSION Knee arthroplasty is rare in patients with KTS. Compared with traditional instrumentation, PSI provides the benefit of minimal tissue dissection which can be advantageous in patients with altered anatomy such as KTS. Multidisciplinary cooperation is vital in terms of dealing with multiple comorbidities in KTS.
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Affiliation(s)
- Xiaohua Wang
- Department of Orthopaedics, Peking University International Hospital, Beijing, China
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Abstract
Vascular anomalies impact the musculoskeletal system dependent on the tissue involved (skin, subcutis, muscle, cartilage, or bone), the extent of involvement, and the type of anomalous vessels (arteries, capillaries, veins, or lymphatics). These malformations can cause a multitude of musculoskeletal problems for the patient. Leg-length discrepancy, intra-articular involvement, muscular lesions, and primary or secondary scoliosis are amongst the issues that patients face. All of these problems can cause pain, deformity, and a range of functional limitations. Surgical and nonsurgical treatment plans have a role in patient care. Patients with vascular anomalies may also suffer from life-threatening cardiovascular and hematologic abnormalities. For those patients who undergo surgery, the thromboembolic risk is elevated, wound breakdown and infection are much more common, and bleeding risk continues well into the postoperative course. Because of the complex nature of these disorders, the clinician must have a full understanding of the types of lesions, their natural history, appropriate diagnostic studies, associated medical problems, indications for treatment, and treatment options. For severe malformations, especially syndromes such as CLOVES and Klippel- Trenaunay syndrome, interdisciplinary team management is essential for the best outcomes.
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Affiliation(s)
- Samantha A Spencer
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States.
| | - Joel I Sorger
- Department of Orthopedics, Cincinnati Children's Medical Center, University of Cincinnati, Cincinnati, OH, United States
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Abstract
PURPOSE OF REVIEW Over the past decade many previously poorly understood vascular malformation disorders have been linked to somatic activating mutations in PIK3CA, which regulates cell survival and growth via activation of the mTOR1-AKT pathway. The goal of this article is to describe and provide an update on the clinical features, complications, and management strategies for the PIK3CA-related overgrowth spectrum (PROS). RECENT FINDINGS PROS encompasses a heterogenous group of disorders with complications related to the tissues harboring the mutation. Vascular malformation syndromes, such as Klippel-Trenaunay syndrome and Congenital Lipomatous Overgrowth Vascular malformations Epidermal nevi and Skeletal abnormalities, have an increased risk of thromboembolic complications, which is accentuated postprocedurally. Asymmetric overgrowth, particularly of limbs, results in a high rate of orthopedic complications. Hypoglycemia screening in the neonatal period and ongoing monitoring for growth failure is recommended in megalencephaly capillary malformation due to its association with multiple endocrinopathies. Recently, sirolimus, an mTOR1 inhibitor, has shown promise in vascular anomalies and now PROS. PIK3CA direct inhibitor, Alpelisib (BYL719), was recently trialed with significant clinical benefit. SUMMARY As the pathogenesis of these conditions is better elucidated and targeted treatments are developed, recognizing the clinical features, comorbidities, and evolving therapeutic landscape across the PROS spectrum becomes more crucial for optimization of care.
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Santos FR, Loson V, Coria A, Martínez H. Conservative management of knee arthropathy in a patient with Klippel Trenaunay syndrome. J Vasc Bras 2020; 19:e20200010. [PMID: 34178075 PMCID: PMC8202177 DOI: 10.1590/1677-5449.200010] [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: 11/21/2022] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare vascular malformation characterized by
capillary malformation, venous malformations, and soft tissue or bone hypertrophy
that affect the extremities in most cases. Knee or hip arthropathy are common
associated conditions and cause serious disability. We present the case of a patient
with a diagnosis of KTS and severe knee arthropathy. A 34-year-old man with KTS was
referred to our hospital with severe knee arthropathy, with the joint fixed in a 90°
position. CT Angiography and MRI of the left leg showed important varicose
development of the superficial venous system with intraarticular vessels. After
discussion of the case by a multidisciplinary committee, the patient was enrolled on
a physiotherapy program and had achieved significant improvements in movement and
quality of life at 12-month follow-up. Treatment of KTS is primarily conservative and
a multidisciplinary approach is necessary.
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Affiliation(s)
- Fanny Rodríguez Santos
- Hospital Italiano de Buenos Aires, General Surgery Department, Phlebolymphology Unit, Buenos Aires, Argentina
| | - Victoria Loson
- Hospital Italiano de Buenos Aires, General Surgery Department, Phlebolymphology Unit, Buenos Aires, Argentina
| | - Agustín Coria
- Hospital Italiano de Buenos Aires, General Surgery Department, Phlebolymphology Unit, Buenos Aires, Argentina
| | - Hugo Martínez
- Hospital Italiano de Buenos Aires, General Surgery Department, Phlebolymphology Unit, Buenos Aires, Argentina
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Cirstoiu C, Cretu B, Sandu C, Dorobat B, Neagu A, Serban B. Failed Attempt of Total Hip Arthroplasty in a Patient with Klippel-Trenaunay Syndrome: A Case Report. JBJS Case Connect 2019; 9:e0103. [PMID: 31644431 DOI: 10.2106/jbjs.cc.19.00103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CASE A 41-year-old man with Klippel-Trenaunay syndrome presented with pain and limited range of motion in his left hip due to secondary hip osteoarthritis. After preoperative assessment, which also included tomography and conventional arteriography, total hip arthroplasty by direct anterior approach was attempted, but rapid blood loss occurred during surgery and the procedure had to be stopped. CONCLUSIONS Total hip arthroplasty should be undertaken with great caution in a patient with Klippel-Trenaunay syndrome. Preoperative conventional arteriography alone may not reveal the true extent of vascular malformations, which may lead to catastrophic results.
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Affiliation(s)
- Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Cretu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristian Sandu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Dorobat
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Angiography, University Emergency Hospital, Bucharest, Romania
| | - Andrei Neagu
- Intensive Care Unit, University Emergency Hospital, Bucharest, Romania
| | - Bogdan Serban
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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