Kovalak Emrah, Can Ata, Stegemann Neşe, Erdoğan Ayşe Övül, Erdoğan Fahri
İstanbul Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
İstanbul Surgery Hospital, Department of Orthopedics and Traumatology, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2015;49(5):503-7. doi: 10.3944/AOTT.2015.14.0304.
A knee fusion is associated with considerable restrictions, including the inability to sit properly, use public transportation, and climb stairs. The purpose of this study is to report and discuss our cases of spontaneous ankylosed knees which were taken down and underwent total knee arthroplasty (TKA).
Six patients who experienced spontaneous ankylosis of the knee undergoing conversion to TKA between 2003-2012 were enrolled retrospectively in this study. The etiology was childhood pyogenic arthritis in 2 patients, intraarticular fractures in 2, gunshot in 1, and juvenile rheumatoid arthritis in 1. The clinical data were recorded with the use of the Hospital for Special Surgery (HSS) knee rating system, Western Ontario and McMaster Questionnaire (WOMAC), and Visual Analog Scale (VAS), preoperatively and postoperatively at final follow-up.
The average follow-up time was 86 months (range: 22-126 months). At the final follow-up, the average range of active flexion was 85° (range: 75-95°). Postoperative average HSS knee rating system was improved from 19.5 (range: 18-22) to 57.49 (range: 46-80), WOMAC was improved from 39.75 (range: 36.4-43) to 62.41 (range: 50.8-74.5). VAS was improved from 9.5 (range: 7-9) to 2.8 (range: 2-4). A pyogenic infection developed in 2 patients; 1 was managed by debridement, and 1 was managed by arthrodesis 2 years later.
The ability to walk and sit in a normal fashion is of great importance for patients. With good preoperative planning and careful handling, gratifying results are possible with TKA.
膝关节融合会带来诸多限制，包括无法正常就坐、乘坐公共交通工具以及上下楼梯。本研究旨在报告并讨论我们对自发融合的膝关节进行松解并实施全膝关节置换术（TKA）的病例。
回顾性纳入2003年至2012年间6例经历膝关节自发融合并接受TKA转换手术的患者。病因包括2例儿童化脓性关节炎、2例关节内骨折、1例枪伤以及1例幼年类风湿关节炎。使用特种外科医院（HSS）膝关节评分系统、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及视觉模拟量表（VAS）在术前及最终随访时记录临床数据。
平均随访时间为86个月（范围：22至126个月）。在最终随访时，主动屈曲的平均范围为85°（范围：75至95°）。术后HSS膝关节评分系统平均从19.5（范围：18至22）提高至57.49（范围：46至80），WOMAC从39.75（范围：36.4至43）提高至62.41（范围：50.8至74.5）。VAS从9.5（范围：7至9）降至2.8（范围：2至4）。2例患者发生化脓性感染；1例通过清创处理，1例在2年后通过关节固定术处理。
能够正常行走和就坐对患者非常重要。通过良好的术前规划和仔细操作，TKA有可能取得令人满意的结果。
