Roberts Conference

July 21, 2005

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

Operative Planning

Patient Requesting TKA

ESR, CRP and WBC all Normal

No Swelling or external evidence of infection

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.

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.