Little information is available regarding the results and complications
of total knee arthroplasty in limbs affected by poliomyelitis with
severe knee degeneration.
We performed a retrospective chart and radiograph review of patients
with a history of poliomyelitis involving a limb that subsequently
underwent primary total knee arthroplasty between 1970 and 2000.
Sixteen total knee arthroplasties were performed in limbs affected
by poliomyelitis in fifteen patients. Eleven patients were followed
for a minimum of two years, one (two knees) died before the minimum
two-year follow-up could be completed, and three were followed for
less than two years. No patient was lost to follow-up.
There were two periprosthetic fractures, one peroneal nerve palsy,
one avulsion of the patellar tendon, and four cases of recurrent
instability. These complications were related to the poor bone quality,
valgus deformity, patella baja, poor musculature, and attenuated
soft tissues commonly found in knees affected by poliomyelitis.
Knee Society pain and knee scores were improved postoperatively
for all nine knees with a two-year follow-up that had had at least
antigravity quadriceps strength prior to surgery. However, Knee
Society function scores remained at 0 or worsened for six of the
eleven knees followed for at least two years, including those with
less than antigravity strength, and four of the nine knees with
at least antigravity strength. None of the prostheses loosened.
Pain and knee scores improved following total knee arthroplasty
in patients with a history of poliomyelitis and antigravity quadriceps
strength, but there was less pain relief in patients with less than
antigravity quadriceps strength. Recurrence of instability and progressive
functional deterioration is possible in all knees affected by poliomyelitis
that have undergone total knee replacement, but they appear to occur more
commonly in more severely affected knees.