II Clinica Ortopedica-IRCCS Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40137, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
J Med Case Rep. 2024 Mar 9;18(1):147. doi: 10.1186/s13256-024-04380-y.
The transition from revision total knee arthroplasty (RTKA) to arthrodesis involves the replacement of cemented femoral and tibial stems with a modular nail designed for arthrodesis. This conversion process is associated with challenges such as bone loss, blood loss, and prolonged surgical durations. Effectively addressing these complexities through a less invasive surgical approach could be pivotal in enhancing patient outcomes and minimizing associated complications.
A 75-year-old white Caucasian female patient with a revision total knee arthroplasty (RTKA) performed with a modular uncemented rotating-hinge system, reporting an history of recurrent patellar dislocation, was referred to our institution after a fall resulting in periprosthetic tibial plateau fracture. The fracture was treated with open reduction and internal fixation, but afterwards the patient had been unable to walk again. Tibial stem was mobilized, and extensor mechanism was insufficient due to chronic incomplete quadriceps tendon rupture. The femoral stem was stable, so we decided to convert the rotating-hinge in a arthrodesis with an uncemented modular knee fusion nail maintaining the previous femoral stem.
The result was a successful arthrodesis with minimal bone and blood loss, reduced operative time, and optimal functional outcome at the one-year follow-up. This case highlights the advantage of using a modular knee revision platform system that gives the opportunity to convert a RTKA in arthrodesis.
翻修全膝关节置换术（RTKA）到关节融合术的转变涉及用设计用于关节融合术的模块化钉来替换粘合的股骨和胫骨柄。这个转换过程伴随着诸如骨丢失、失血和手术时间延长等挑战。通过微创手术方法有效地解决这些复杂性问题可能对于提高患者的治疗效果和减少相关并发症至关重要。
一位 75 岁的白人女性患者，因复发性髌骨脱位在接受模块化非粘合旋转铰链系统的 RTKA 后，在一次跌倒导致假体周围胫骨平台骨折后被转介到我们医院。骨折采用切开复位内固定治疗，但此后患者再次无法行走。胫骨柄松动，伸肌机制不足，因为慢性不完全股四头肌腱断裂。股骨柄稳定，所以我们决定将旋转铰链转换为关节融合术，使用非粘合模块化膝关节融合钉固定先前的股骨柄。
结果是在 1 年随访时取得了成功的融合，骨量和失血量最小，手术时间缩短，功能结果最佳。这个病例突出了使用模块化膝关节翻修平台系统的优势，它提供了将 RTKA 转换为关节融合术的机会。
