Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China.
School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Sydney, Australia.
Orthop Surg. 2023 May;15(5):1423-1430. doi: 10.1111/os.13686. Epub 2023 Mar 1.
Neuroarthropathy of the knee or Charcot knee, leading to chronic joint destruction, is a rare disease that is difficult to diagnose. The treatment of this condition is difficult and controversial.
A 74-year-old Asian woman has had bilateral knee pain for 22 years and deformity for 10 years, which has been aggravating for 2 months. Physical examination showed bilateral knee varus deformity greater than 15°, and -20 to 90° range of motion. X-ray revealed bilateral varus deformity with massive free body hyperplasia. Combined with medical history as syringomyelia, the patient was diagnosed with bilateral Charcot knees and bilateral joint replacements were performed using Legacy Constrained Condylar Knee prostheses (LCCK; Zimmer, USA). The patient reported satisfactory treatment outcomes, pain relief, and improved range of motion in both knees, without postoperative complications or prosthesis loosening at 2 year after operation.
Total knee arthroplasty (TKA) may be considered a viable option for treating the Charcot knee. The use of constrained condylar prostheses can produce satisfactory results. Attention should be given to survival risks, complications, and other potential determining factors associated with TKA when devising a treatment strategy for the Charcot knee.
膝神经关节病,又称夏科膝,导致慢性关节破坏,是一种罕见疾病,难以诊断。这种情况的治疗很困难,且存在争议。
一名 74 岁的亚洲女性,双侧膝关节疼痛 22 年,畸形 10 年,近 2 个月加重。体格检查显示双侧膝内翻畸形大于 15°,活动度为-20°至 90°。X 线显示双侧内翻畸形伴大量游离体增生。结合病史为脊髓空洞症,患者被诊断为双侧夏科膝,采用 Legacy Constrained Condylar Knee 假体(LCCK;Zimmer,美国)进行双侧膝关节置换术。术后 2 年,患者报告治疗效果满意,疼痛缓解,双膝活动度改善,无术后并发症或假体松动。
全膝关节置换术(TKA)可能是治疗夏科膝的一种可行选择。使用约束性髁假体可获得满意的效果。在制定夏科膝的治疗策略时,应注意与 TKA 相关的生存风险、并发症和其他潜在决定因素。