Secondary Knee Osteoarthritis with Medial Instability and Tibial Defect due to Chronic Abscess Treated by Total Knee Arthroplasty with Metal Augmentation - Case Report
Abstract
Background:Knee osteoarthritis (OA), known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage, most common in elderly women and men. Knee OA is a leading cause of disability and increase with an aging and overweight population. Total Knee Arthroplasty (TKA) is a common surgical treatment of OA knee that highly cost-effective procedure. Stable placement of components is difficult and thus it presents technical challenges for the surgeon but various options are available for managing these defects.
Case Report: A 58 years-old housewife came to our clinic due to chronic left knee pain with associated instability since two years ago and getting worse in last three months. She already had knee joint supplementation injections and physical therapy but no improvements. Based on our clinical and radiological findings, our assessment was secondary left knee osteo-arthritis with medial instability and tibial defect due to chronic abscess. Patient underwent TKA to correct this condition. A revised implant was used to close the defect in the medial part of the tibia and soft tissue reconstruction procedure was used to correct the instability.
Result: On the first postoperative month, the patient underwent rehabilitation and physical therapy to strengthen her lower limb muscles. On the second month, she started to walk using walking assisted device. On the ninth months follow-up, the patient was able to walk normally without assisted device, the pain disappeared and the symptoms of knee instability were reduced.
Conclusion:Bone defects are commonly encountered during TKA, which still has no standard treatment to cure. In this case, the use of metal augmentation with revision implant give satisfactory results with good clinical outcome.
Keywords: Osteoarthritis, Total Knee Arthro¬plasty, knee instability, tibial defect, metal augmentation
Correspondence:
Bintang Soetjahjo. Dr. Moewardi Hospital. Jl. Kolonel Sutarto 132, Jebres, Surakarta, Central Java 57126, Indonesia. Mobile: +628122987359. Email: bjortho@yahoo.com
Indonesian Journal of Medicine (2021), 06(02): 168-176
References
Chang MJ, Lim H, Lee, NR, Moon, YW (2014). Diagnosis, causes and treatments of instability following total knee arthroplasty. Knee Surg. Relat. Res. 26(2): 61–67. https://doi.org/10.5792/ksrr.2014.26.2.61.
Cuckler JM (2004). Bone loss in total knee arthroplasty: Graft augment and options. J Arthroplasty. 19(4 Suppl 1): 56–58. https://doi.org/10.1016/j.arth.2004.03.002.
Eckstein F, Kwoh CK, Boudreau RM, Wang Z, Hannon MJ, Cotofana S, Hudelmaier MI, et al. (2013). Quantitative MRI measures of cartilage predict knee replacement: A case-control study from the Osteoarthritis Initiative. Ann Rheum Dis. 72(5): 707–714. https://doi.org/10.1136/annrheumdis 2011-201164.
Elsiwy Y, Jovanovic I, Doma K, Hazratwala K, Letson H (2019). Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: A systematic review. J Orthop Surg Res. 14(1): 15. https://doi.org/10.1186/s13018-018-1058-9.
Furtado C, Deshpande M, Dias A (2016). Clinical profile of patients undergoing total knee replacement (TKR) case based series. IOSR J Dent Med Sci. 15(1): 95–101. https://doi.org/10.979-0/0853-151395101.
Huten D (2013). Femorotibial bone loss during revision total knee arthroplasty. Orthop Traumatol Surg Res. 99(1): S22–S33. https://doi.org/10.1016/j.otsr.2012.11.009.
Ji JH, Park SE, Song IS, Kang H, Ha JY, Jeong JJ (2014). Complications of medial unicompartmental knee arthroplasty. Clin Orthop Surg. 6(4): 365–372. https://doi.org/10.4055/cios.2014.6.4.365.
Lee JK, Choi CH (2011). Management of tibial bone defects with metal augmentation in primary total knee replacement. J Bone Joint Surg Br. 93(11): 1493–1496. https://doi.org/10.1302/0301-620x.93b10.27136.
Lee KJ, Bae KC, Cho CH, Son ES, Jung JW (2016). Radiological stability after revision of infected total knee arthroplasty using modular metal augments. Knee Surg Relat Res. 28(1): 55–61. https://doi.org/10.5792/ksrr.2016.28.1.5.
Mancuso CA, Ranawat CS, Esdaile JM, Johanson NA, Charlson ME (1996). Indications for total hip and total knee arthroplasties: Results of orthopaedic surveys. J Arthroplasty. 11(1): 34–46. https://doi.org/10.1016/s0883-5403(96)80159-8.
Manen MDV, Nace J, Mont, MA (2012). Management of primary knee osteoarthritis and indications for total knee arthroplasty for general practitioners. J Am Osteopat. Assoc. 112(11): 709–715. https://doi.org/10.7556/jaoa.20-12.112.11.709.
Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, Dragomir A, et al (2008). Lifetime risk of symptomatic knee osteoarthritis. Arthritis Care Res. 59(9): 1207–1213. https://doi.org/10.1002/art.24021.
Nilsson ÅL Dencker A, Palstam A, Person G, Horton MC, Escorpizo R, Küçük-deveci AA, et al (2018). Patient reported outcome measures in osteoarthritis: A systematic search and review of their use and psychometric properties. RMD Open. 4(2): e000715. https://doi.org/10.1136/rmdopen-2018-000715.
Onur T, Wu R, Metz L, Dang A (2014). Characterisation of osteoarthritis in a small animal model of type 2 diabetes mellitus. Bone Joint Res. 3(6): 203–211. doi.org/10.1302/2046-3758.36.2000244.
Patel JV, Masonis JL, Guerin J, Bourne RB, Rorabeck CH (2004). The fate of augments to treat type 2 bone defects in revision knee arthroplasty. J Bone Joint Surg Br. 86(2): 195–199. https://doi.org/10.1302/0301-620x.86b2.13564.
Qiu YY, Yan CH, Chiu KY, Ng FY (2011). Review article: Bone defect classifications in revision total knee arthroplasty. J Orthop Surg. (Hong Kong). 19(2): 238–43. https://doi.org/10.11-77/230949901101900223.
Qiu YY, Yan CH, Chiu KY, Ng FY (2012). Review article: Treatments for bone loss in revision total knee arthroplasty. J Orthop Surg (Hong Kong). 20(1): 78–86. https://doi.org/10.11-77/230949901202000116.
Raya SA, Raya AA, Helmii M (2012). Duloxetine for the management of pain in older adults with knee osteoarthritis: Randomised placebo-controlled trial. Age Ageing. 41(5): 646–652. https://doi.org/10.1093/ageing/afs072.
Rytter S, Egund N, Jensen LK, Bonde JP (2009). Occupational kneeling and radiographic tibiofemoral and patella femoral osteoarthritis. J Occup Med Toxicol. 4: 19. https://dx.doi.org/10.1186%2F1745-6673-4-19.
Springer BD (2019). Management of the Bariatric Patient. What are the implications of obesity and total joint arthroplasty: The Orthopedic Sur-geon’s Perspective?. J Arthroplasty. 34(7S): S30–S32. https://doi.org/10.1016/j.arth.2018.12.021.
Tsukada S, Wakui M, Matsueda M (2013). Metal block augmentation for bone defects of the medial tibia during primary total knee arthroplasty. J Orthop Surg Res. 8: 36. https://doi.org/10.1186/1749-799x-8-36.
Wen CY, Chen Y, Tang HL, Yan CH, Lu WW, Chiu KY (2013). Bone loss at subchondral plate in knee osteoarthritis patients with hypertension and type 2 diabetes mellitus. Osteoarthritis Cartilage. 21(11): 1716-23. https://doi.org/10.1016/j.joca.2013.06.027.
Werle JR, Goodman SB, Imrie SN (2002). Revision total knee arthroplasty using large distal femoral augments for severe metaphyseal bone deficiency: A preliminary study. Orthopedics. 25 (3): 325–7. https://doi.org/10.3928/0147-7447-20020301-17.
Werner A, Jäger M, Schmitz H, Krauspe R (2003). Joint preserving surgery for osteonecrosis and osteochondral defects after chemotherapy in childhood. Klin Padiatr. 215(6): 332–337. https://doi.org/10.1055/s2003-454-95.
Wood GC, Naudie DDR, MacDonald SJ, McCalden RW, Bourne RB (2009). Results of pressfit stems in revision knee Arthroplasties. Clin Orthop Relat Res. 467(3): 810–817. https://doi.org/10.1007/s11999-008-0621-9.
Zeni JA, Mackler LS (2010). Clinical outcomes after simultaneous bilateral total knee arthroplasty. Comparison to unilateral total knee arthroplasty and healthy controls. J Arthroplasty. 25(4): 541–546. https://doi.org/10.1016/j.arth.2009.02.016.
