The technique and clinical result of total knee replacement in flexion ankylosed knee / 中华骨科杂志

ABSTRACT

Objective To explore the techniq ue and clinical result of total knee replacement in flex-ion ankylosed knee.Me thods From December1987to December2000,30TKRs in16patients were per formed by means of medial parapatellar approach,secondary osteotomy and soft tissue balance for knees with bony ankylosis in flexion position.At the same t ime,an appropriate technique was adopted to excise the patella-femoral joint while the femoral-tibial joint was ankylosed,so that the bone distribution an d the ori-entation of joint line were made appropriately to facilitate implan t prostheses.By measuring the range of mo-tion(ROM)and HSS score system ,the effects of this operative methods and the procedure of osteoto my were evaluated.In this group,there were12males and4females.The average age at s urgery was33.6years old(range,20to69years).All knees were fixed at a n average of 46.5?(range,15?to95?),with ROM of 0?.HSS scores w ere in average of 31.4points(16to47points).Of the16cases,14cases underwent bilat-eral TKRs,and2cases unilateral TKR.Results In the present series,the operative time lasted for 1.6hours(range,1.2to2.1h)ther e were3cases suffering from paralysis of unilateral common peroneal nerve for half a year,there was no other complication happened in this group.The mean f ollow-up was67.1months(range,1to14years),the average ROM of knee wa s72.5?(range,60?to100?),lack of full ex ten sion(ex-tension l ag)was7.8?(range,0?to15?).HSS of knee joint was average78.7p oints(range,71to89points),Comparing with the pre-operation,there was i mprovement of 47.3scores.Conclusion Al though it is more difficult to perf orm TKRS in bony ankylosed knee than in those without ankylosis,how ever,by using tech niques of medial parapatellar approach,secondary osteotomy,soft ti ssue balance and the appropriate way to ex cise patellar-femoral joint and fem ur-tibial joint which were naturally ankylosed,the ankylosed knee defor mi ti es could be corrected successfully,and TKR is also possible to improve the func tion of knee and life quali ty in these patients significantly.