Clin Orthop Surg.  2014 Dec;6(4):476-479. 10.4055/cios.2014.6.4.476.

Total Knee Arthroplasty in Patients with Ipsilateral Fused Hip: A Technical Note

• Goodman SB
• Huddleston JI
• Hur D
• Song SJ

• KMID: 1794738
• DOI: http://doi.org/10.4055/cios.2014.6.4.476

Abstract

We report the surgical technique used to perform posterior-stabilized total knee arthroplasty (TKA) in two patients with a well positioned and functional hip arthrodesis. Intraoperatively, the operating table was placed in an increased Trendelenburg position. Episodically, we flexed the foot of the table by 90degrees to allow maximal knee flexion to facilitate exposure and bone cuts. We opted to resect the patella and tibia first to enable exposure, given the stiffness of the arthritic knee. One patient's medical condition prohibited complex conversion total hip arthroplasty (THA) prior to the TKA. The other patient's scarred soft tissues around the hip, due to chronic infection and multiple operations, made THA risky. The final outcome provided satisfactory results at a minimum of 2 years postoperatively. TKA can be successfully performed with adjustments of table position and modification of the sequence of surgical steps in patients with ipsilateral hip fusion.

Keyword

Knee; Arthroplasty; Hip; Arthrodesis

MeSH Terms

Acetabulum/injuries/surgery
Aged, 80 and over
*Arthrodesis
Arthroplasty, Replacement, Knee/*methods
Fractures, Bone/surgery
Hip Fractures/*surgery
Hip Injuries/surgery
Humans
Male
Middle Aged
Osteoarthritis, Knee/*surgery
War

Figure

• 

  Fig. 1 The position of the table during the tibial and femoral bone resection. (A) A tibial resection can be performed accurately using an extramedullary guide system in the Trendelenburg position even though the patients' knees were stiff preoperatively. (B) Gentle flexion of the knee can be performed after the tibial resection, and the femoral intramedullary guide system could be placed safely.

• 

  Fig. 2 Preoperative and postoperative radiographs of case 1. (A) Total knee arthroplasty was performed in an 87-year-old man with an ipsilateral fused hip. His chronological age, medical condition, and satisfactory position of the fused hip made total hip arthroplasty prior to the total knee arthroplasty unnecessary. (B) Positioning of the implants and alignment of the lower extremity were satisfactory.

• 

  Fig. 3 Postoperative radiographs of case 2. Total knee arthroplasty was performed in a 63-year-old man with an ipsilateral fused hip in satisfactory position. His infection history, soft tissue atrophy, and scarring around the fused hip made total hip arthroplasty prior to the total knee arthroplasty risky. Positioning of the implants and alignment of the lower extremity were satisfactory.

Reference

1. Callaghan JJ, Brand RA, Pedersen DR. Hip arthrodesis: a long-term follow-up. J Bone Joint Surg Am. 1985; 67(9):1328–1335.

2. Romness DW, Morrey BF. Total knee arthroplasty in patients with prior ipsilateral hip fusion. J Arthroplasty. 1992; 7(1):63–70.

3. Rittmeister M, Starker M, Zichner L. Hip and knee replacement after longstanding hip arthrodesis. Clin Orthop Relat Res. 2000; (371):136–145.

4. Aderinto J, Lulu OB, Backstein DJ, Safir O, Gross AE. Functional results and complications following conversion of hip fusion to total hip replacement. J Bone Joint Surg Br. 2012; 94:11 Suppl A. 36–41.

5. Beaule PE, Matta JM, Mast JW. Hip arthrodesis: current indications and techniques. J Am Acad Orthop Surg. 2002; 10(4):249–258.

6. Joshi AB, Markovic L, Hardinge K, Murphy JC. Conversion of a fused hip to total hip arthroplasty. J Bone Joint Surg Am. 2002; 84(8):1335–1341.

7. Stover MD, Beaule PE, Matta JM, Mast JW. Hip arthrodesis: a procedure for the new millennium? Clin Orthop Relat Res. 2004; (418):126–133.

8. Garvin KL, Pellicci PM, Windsor RE, Conrad EU, Insall JN, Salvati EA. Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip. J Bone Joint Surg Am. 1989; 71(9):1355–1362.

9. Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989; (248):9–12.