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Total Knee Arthroplasty After Knee Arthrodesis: Patient Case Study and Literature Review

This case study focuses on a 64-year-old male with a history of left knee arthrodesis after total knee arthroplasty (TKA). The patient, significantly short on the affected side, experienced two falls leading to hip fractures. Successful operative planning was executed for the right TKA as the patient requested conversion from arthrodesis. Normal ESR, CRP, and WBC levels were recorded, with no signs of infection. Literature reviews reveal varied failure rates of conversion procedures, underscoring the complexity and risks involved in cases of previously fused joints.

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Total Knee Arthroplasty After Knee Arthrodesis: Patient Case Study and Literature Review

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  1. Roberts Conference July 21, 2005

  2. History • 64 year old male • 6 yrs s/p Left Knee Arthrodesis following TKA • Significantly short on affected side • 2 falls resulting in Hip Fractures • Successful TKA on Right

  3. Operative Planning • Patient Requesting TKA • ESR, CRP and WBC all Normal • No Swelling or external evidence of infection

  4. Conversion Athrodesis to TKA • Kreder et. al: 18 knees  28% failure (infection, component failure) • Cameron and Hu: 17 knees  53% failure (tibial component loosening, ligamentous laxity, quad rupture, wound breakdown, repeat athrodesis) • Kim et. al: 30 knees  53% failure; mean flexion 75 deg, 9 deg extension deficit • Henkel et. al: 7 knees  29% failure; 71% re-operation; most with increased pain on walking • Warner: Three phase “Judet quadricepsplasty” to mobilize extensor mechanism.

  5. Holden DL, Jackson DW. Considerations in total knee arthroplasty following previous knee fusion. Clin Orthop.1988; 227:223 -8. • Kreder HJ, Williams JI, Jaglal S, Axcell T, Stephen D. A population study in the Province of Ontario of the complications after conversion of hip or knee arthrodesis to total joint replacement. Can J Surg.1999; 42:433 -9. • Bradley GW, Freeman MA, Albrektsson BE. Total prosthetic replacement of ankylosed knees. J Arthroplasty. 1987;2:179 -83. • Cameron HU. Role of total knee replacement in failed knee fusions. Can J Surg.1987; 30:25 -7. • Naranja RJ Jr, Lotke PA, Pagnano MW, Hanssen AD. Total knee arthroplasty in a previously ankylosed or arthrodesed knee. Clin Orthop. 1996;331 : 234-7. • Henkel TR, Boldt JG, Drobny TK, Munzinger UK. Total knee arthroplasty after formal knee fusion using unconstrained and semiconstrained components: a report of 7 cases. J Arthroplasty.2001; 16:768 -76. • Cameron HU, Hu C. Results of total knee arthroplasty following takedown of formal knee fusion. J Arthroplasty. 1996;11:732 -7. • Warner JP. The Judet quadricepsplasty for management of severe posttraumatic extension contracture of the knee. A report of a bilateral case and review of the literature. Clin Orthop.1990; 256:169 -73.

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