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Custom rotating-hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Spina bifida (SB) is a congenital disorder which may result in a number of musculoskeletal problems. Total knee replacement (TKR) in this patient group is technically demanding due to bone deformity, soft tissue contracture, muscle tone abnormality and ligament insufficiency. This is a retrospective review of three patients with SB and disabling knee arthritis who were managed with a custom rotating-hinge (RHK) total knee system. All patients reported an improvement in knee pain and stability at mean follow-up 47 months (43–53). Mean Oxford Knee score improved from 21 preoperatively to 32 at final follow-up. One patient required revision of tibial and patella components at 37 months for lateral patella instability and excessive wear. Custom RHK for patients with SB, severe neuromuscular dysfunction and bone deformity relieves pain, restores stability and improves early knee function; however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary TKR in the general population.

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References

  1. Atinga M, Hamer AJ (2008) Total knee replacements in a patient with the Morquio syndrome. JBJS [Br] 90:1631–1633

    CAS  Google Scholar 

  2. Back DL, Cannon SR, Hilton A, Bankes MJ, Briggs TW (2001) The kinemax total knee arthroplasty—nine years experience. JBJS [Br] 83:359–363

    Article  CAS  Google Scholar 

  3. Back DL, David L, Hilton A, Blunn G, Briggs TW, Cannon SR (2008) The SMILES prosthesis in salvage revision knee surgery. Knee 15:40–44

    Article  PubMed  CAS  Google Scholar 

  4. Cameron HU, Hu C, Vyamont D (1997) Hinge total knee replacement revisited. Can J Surg 40:278–283

    PubMed  CAS  Google Scholar 

  5. Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. JBJS [Br] 80:63–69

    Article  CAS  Google Scholar 

  6. Giori NJ, Lewallen DG (2002) Total knee arthroplasty in limbs affected by poliomyelitis. JBJS [Am] 84:1157–1161

    Google Scholar 

  7. Helenius I, Remes V, Lohman M, Tallroth K, Poussa M, Helenius M, Paavilainen T (2003) Total knee arthroplasty in patients with diastrophic dysplasia. JBJS [Am] 85:2097–2102

    Google Scholar 

  8. Morrissey RT, Weinstein SL (2006) Lovell and winters paediatric orthopaedics, 6th edn. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  9. Nagarkatti DG, Thomson JD (2000) Charcot arthropathy in spina bifida. J Pediatr Orthop 20(1):82–87

    Article  PubMed  CAS  Google Scholar 

  10. Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF (2007) Rotating hinged total knee replacement: use with caution. JBJS [Am] 89:1735–1741

    Article  Google Scholar 

  11. Rand JA, Chao EY, Stauffer RN (1987) Kinematic rotating hinge knee arthroplasty. JBJS [Am] 69:489–497

    CAS  Google Scholar 

  12. Shin M, Besser LM, Siffel C, Kucik JE, Shaw GM, Lu C, Correa A (2010) Prevalence of spina bifida among children and adolescents in 10 regions in the United States. Paediatrics 126:274–279

    Article  Google Scholar 

  13. Tigani D, Fosco M, Amendola L, Boriani L (2009) Total knee arthroplasty in patients with poliomyelitis. Knee 16:501–506

    Article  PubMed  CAS  Google Scholar 

  14. Walker PS, Emerson R, Potter T, Scott R, Thomas WH, Turner RH (1982) The kinematic rotating hinge: biomechanics and clinical application. Orthop Clin N Am 13:187–199

    CAS  Google Scholar 

Download references

Acknowledgments

The authors acknowledge the contribution made by Stanmore Implants Worldwide Ltd, and particularly Dr Paul Unwin.

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No conflict of interests declared.

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Correspondence to N. Al-Hadithy.

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Sewell, M.D., Al-Hadithy, N., Hanna, S.A. et al. Custom rotating-hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction. Arch Orthop Trauma Surg 132, 1321–1325 (2012). https://doi.org/10.1007/s00402-012-1539-y

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  • DOI: https://doi.org/10.1007/s00402-012-1539-y

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