Department of Orthopaedic Surgery, University Clinics of Basel, Spitalstr, 21, CH-4031 Basel, Switzerland.
BMC Musculoskelet Disord. 2011 Oct 13;12:233. doi: 10.1186/1471-2474-12-233.
Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components.
We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA.
Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.
踝关节同时发生骨关节炎（OA）会使原发性全膝关节置换术（TKA）复杂化。在这种情况下，TKA 的康复受到使人虚弱的踝关节疼痛的限制，但内翻或外翻踝关节关节炎甚至可能影响膝关节假体组件的放置。
我们介绍了一位同时患有双侧膝关节外翻和髌股关节炎以及双侧踝关节内翻 OA 的患者，这些问题共同导致了整体残疾。这位 63 岁的患者，身体状况良好，动力十足，他接受了双侧全膝关节和踝关节置换术（ quadruple total joint arthroplasty，TJA）的同期治疗，在同一次麻醉下进行。两年的结果显示，所有四个置换关节的对线和功能都非常出色。与单独进行 TJA 的常规治疗相比，该特殊患者的康复时间（第 6 周）、重返工作岗位时间（第 6 周）和住院时间（12 天）明显缩短。
在双侧畸形膝关节和踝关节同样致残性 OA 患者中，同期行 quadruple TJA 可获得更好的功能结果和更快的康复，优于文献中报告的 TKA 和 TAA 后的平均结果。然而，仔细的术前规划、广泛的患者教育以及两个完整的手术团队被认为是成功实施的关键因素。据我们所知，这是文献中首例关于在同一次麻醉下为同一患者同期植入 quadruple major total joint arthroplasty 的病例报告。
