Artikel
Posttraumatic collateral instability and total knee arthroplasty: revision and repair
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Autoren
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J. Ohnsorge
- Orthopaedische Universitaetsklinik, Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen
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R. Laskin
- New York
| Veröffentlicht: | 13. Juni 2005 |
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Gliederung
Text
Introduction
A 53 year-old woman presented with an unstable and painful total knee arthroplasty 6 months postoperatively. Disruption of both collateral ligaments as a young adult and the subsequent arthritis required repeated surgical and extensive conservative treatment before a prosthesis was implanted. Examination disclosed a marked instability of the LCL and loosening of the tibial and the femoral
component. MRI failed to show adequate continuity of the scarred stabilizing collateral structures of the femuro-fibular compartment. Therapeutical management of the two-fold problem requested critical consideration of various options and individual premises.
Materials and Methods
A one-stage revision arthroplasty was performed using a modular non-articulated constrained prosthesis and a bone-tendon-bone allograft to reconstruct the LCL. Continuous passive motion began immediately after surgery and was gradually increased to 90° of flexion. Physiotherapy was effected on a daily basis with the knee sheltered in a brace and the patient using crutches. Weight-bearing was initially limited to toe-touch.
Results
Postoperative rehabilitation was undisturbed and fast. The clinical and radiographic follow-up showed correct alignment and function. Pain free motion was achieved within 0-115° flexion at three months after surgery and the patient had returned to her normal activities.
Discussion
The review of literature revealed different aspects and provisos of a combined treatment of soft-tissue lesion and prosthetic loosening. Standards needed to be verified with regard to the individual demands of the patient. Despite the favourable outcome, alternatives remain debatable.
