gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2018)

23.10. - 26.10.2018, Berlin

Bilateral knee replacement with flexion anchylosis in PWH

Meeting Abstract

  • presenting/speaker Horacio Caviglia - General Hospital Juan A. Fernandez, Haemophilia Argentinian Foundation, CABA, Argentina
  • Gustavo Galatro - General Hospital Juan A. Fernandez, CABA, Argentina
  • Guillermo del Soldato - General Hospital Juan A. Fernandez, CABA, Argentina
  • Daniela Neme - Fundacion de la Hemofilia, CABA, Argentina

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocPT17-1096

doi: 10.3205/18dkou664, urn:nbn:de:0183-18dkou6648

Published: November 6, 2018

© 2018 Caviglia et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Limitation of movement and flexion deformity makes difficult to perform knee replacement. This situation is common in the patient with haemophilia. Anchylosis more than 90º flexion makes TKR procedure more complex.

The extensor apparatus of the knee has bone and fibrous adhesion which makes the release of the extensor apparatus very difficult. There are no descriptions that explain how to proceed in these patients.

Objectives: The objective of this work is to describe the surgical steps necessary to achieve TKR in anchylosis more than 90º in PWH.

Methods: Patient with 37 years old with 90º right knee, and 85º left knee of flexion anchylosis, 4 years of evolution. The patient use wheelchair for displacement.

Patient received VIII factor bolus before performing the procedure.

Technical procedure:

1.
Anterior approach centred on the knee,
2.
Exposure of the extensor apparatus,
3.
Osteotomy of anterior tibial tubercle,
4.
Patellar osteotomy in the bone union with the articular surface. In this way the extensor apparatus is released and all adhesions can be removed from to the nearby tissues.
5.
The osteotomy of the tibial plate is performed 0.5 cm from the articular surface. This osteotomy is performed without any guidance and the direction of the saw is parallel to the tibial surface. Then the knee can be flexed 120º,
6.
The fixation of the tibial plate is separated from the femoral by means of the electro scalpel and osteotomo. Once the tibial fragment is resected, the femoral condyle is exposed free to continue the usual technique with the femoral guides,
7.
With the knee in flexion of 120 º the tibia is carried forward and the osteotomy performed in tibia is exposed and the conventional guides can be used.

Results: Both knees were operated and TKR could be performed with this technique. Six weeks after the procedure, both knees reached 90° of flexion and 0° and -10° of extension, right and left respectively; the patient also can stand up and start walking rehabilitation plan.

Conclusions: This surgical technique is| describe for the TKR with 90° knee anchylosis in PWH. This technique may facilitate the practice for surgeons that perform articular replacement in PWH.