Scientific Article   |    
Conversion of a Fused Knee with Use of a Posterior Stabilized Total Knee Prosthesis
Young-Hoo Kim, MD; S.-H. Oh, MD; J.-S. Kim, MD
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Investigation performed at The Joint Replacement Center of Korea, Seoul, Korea

Young-Hoo Kim, MD
S.-H. Oh, MD
J.-S. Kim, MD
The Joint Replacement Center of Korea, 627-3, JaYang-1Dong, KwangJin-Gu, Seoul 143-191, Korea. E-mail address for Y.-H. Kim: younghookim@netsgo.com

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Poster presentation at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Dallas, Texas, February 13 through 17, 2002.

J Bone Joint Surg Am, 2003 Jun 01;85(6):1047-1050
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Background: Typically a hinged or condylar constrained prosthesis is recommended for total knee arthroplasty in a fused knee, to substitute for the absent or deficient collateral ligaments. The purpose of this study was to evaluate the stability and clinical results after the use of a posterior stabilized prosthesis in the conversion of a fused knee to a total knee arthroplasty.

Methods: Thirty-six patients (thirty-six knees) with a mean age of 39.2 years underwent conversion of a fused knee to a total knee arthroplasty with a posterior stabilized prosthesis. The mean duration of ankylosis had been 24.5 years. Clinical and radiographic evaluation was carried out preoperatively; at six weeks and three, six, and twelve months postoperatively; and annually thereafter. The mean duration of follow-up was 7.7 years.

Results: The mean preoperative Hospital for Special Surgery knee score of 60 points improved to 83.2 points at the final follow-up examination. Twenty-two knees were pain-free, and the remaining fourteen were mildly painful after prolonged walking. The mean amount of active flexion in the entire group was 77.7°. The extension lag in the entire group averaged 12.5°. Complications included necrosis of the skin edges in eighteen knees (50%), a rupture of the quadriceps tendon in two patients, and a pyogenic infection in two. No prosthesis required revision because of clinical or radiographic loosening.

Conclusions: We believe that when the soft-tissue sleeves in a previously fused knee are carefully preserved intraoperatively, they can provide adequate stability after total knee arthroplasty with a posterior stabilized prosthesis. Therefore, we believe that use of that type of prosthesis is a reasonable alternative to the use of a more constrained implant in the treatment of this condition.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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